Elver Ashlie A, Wirtz Katy, Hu Jinxiang, Daon Emmanuel
University of Kansas School of Medicine, Kansas City, KS.
University of Kansas Health System, Kansas City, KS.
Kans J Med. 2021 Nov 5;14(3):269-272. doi: 10.17161/kjm.vol14.15506. eCollection 2021.
Mediastinitis is a deadly surgical site infection (SSI) after cardiac surgery. Although rare, mortality is as high as 47%. Best practices for infection prevention to eliminate this deadly complication must be identified. Surgical dressings impregnated with silver have been shown to reduce SSIs in other surgical specialties. The aim of this study was to determine if the routine use of silver surgical dressings is beneficial to prevent mediastinitis after cardiac surgery.
A single-center retrospective study was performed on patients who underwent sternotomy from 2016 to 2018 at the University of Kansas Medical Center. Prior to June 2017, all cardiac surgical patients were treated with gauze surgical dressings and designated as Group A. The routine use of silver-impregnated surgical dressings was implemented in June 2017; patients after this change in practice were designated as Group B. Patient characteristics and rates of deep and superficial sternal wound infections (SWI) were compared.
There were 464 patients in Group A and 505 in Group B. There were seven SWIs in Group A (7/464, 1.5%) and five in Group B (5/505, 1%; p = 0.57). Of these, there was one deep SWI per group (p = 0.61) and six superficial SWIs in Group A compared to four in Group B (p = 0.74). Severe COPD was higher in Group A (p = 0.04) and peak glucose was higher in Group B (p = 0.02).
The analysis conferred no benefit with silver-impregnated surgical dressings to prevent mediastinitis. Choice of gauze surgical dressings may be preferable to reduce cost.
纵隔炎是心脏手术后一种致命的手术部位感染（SSI）。尽管罕见，但其死亡率高达47%。必须确定预防感染以消除这种致命并发症的最佳做法。已表明含银手术敷料可减少其他外科专科的手术部位感染。本研究的目的是确定常规使用银手术敷料是否有利于预防心脏手术后的纵隔炎。
对2016年至2018年在堪萨斯大学医学中心接受胸骨切开术的患者进行单中心回顾性研究。2017年6月之前，所有心脏手术患者均使用纱布手术敷料治疗，并指定为A组。2017年6月开始常规使用含银手术敷料；在此实践改变后的患者指定为B组。比较患者特征以及深部和浅部胸骨伤口感染（SWI）的发生率。
A组有464例患者，B组有505例患者。A组有7例SWI（7/464，1.5%），B组有5例（5/505，1%；p = 0.57）。其中，每组各有1例深部SWI（p = 0.61），A组有6例浅部SWI，B组有4例（p = 0.74）。A组重度慢性阻塞性肺疾病（COPD）患者比例较高（p = 0.04），B组血糖峰值较高（p = 0.02）。
分析表明含银手术敷料对预防纵隔炎无益处。选择纱布手术敷料可能更可取，以降低成本。
