Local application of gentamicin-containing collagen implant in the prophylaxis and treatment of surgical site infection following cardiac surgery

BackgroundFor the cardiac surgeon and patient the development of sternal wound infection is a serious post-operative complication associated with increased risk of death and also considerable morbidity.MethodsNine publications were identified using the PubMed online database and search terms ‘gentamicin-containing collagen implant’ plus ‘surgical site infection’, ‘wound infection’ and ‘cardiac surgery’.ResultsSix out of eight studies demonstrated that prophylactic use of gentamicin-containing collagen implants (GCCI) significantly reduce the wound infection rate following cardiac surgery (via sternotomy) compared to standard treatment alone. The adjunctive use of GCCI is particularly beneficial in high-risk subjects e.g. diabetes and obese patients. GCCI significantly improve the morbidity associated with SSI following cardiac surgery by shortening the recovery phase and length of hospital stay; reducing the need for surgical revision and use of antibiotics. GCCI have been shown to be cost saving across a wide spectrum of patients. A further study has shown that GCCI may also have a therapeutic role to play in patients with deep sternal wounds.ConclusionThis review demonstrates that when used dry prior to insertion GCCI can be effective in reducing the rate of SSI following cardiac surgery. GCCI have also been shown to be cost saving as they reduce the substantial morbidity associated with deep SSI. The adjunctive use of GCCI is particularly beneficial in high-risk patients. GCCI may also have a role to play in the treatment of deep sternal wound infection.