Original researchGentamicin-containing collagen implant reduces sternal wound complications after cardiac surgery: A retrospective analysis

•Addition of GCCI to systemic antibiotic prophylaxis reduces the risk of SWI.•These results were obtained in high-risk patients undergoing cardiac surgery.•GCCI should be used dry prior to insertion to optimize the prophylactic effect.•New risk factors may help to profile patients at risk of developing SWI.

Introduction: The majority of evidence for use of gentamicin-containing collagen implants (GCCI) demonstrates a positive impact on infection prophylaxis despite the equivocal results of a recently published large-scale study. The primary aim of the study was to evaluate the impact of prophylactic use of GCCI on SWI following cardiac surgery in a routine clinical setting. A secondary aim was to identify the risk factors for SWI among the patient cohort. Methods: A consecutive series of patients who had undergone sternotomy were analysed on a retrospective basis. Patient characteristics, risk factors and procedure-related variables were analysed for Group I (superficial sternal wound infection [SSWI]) and Group II (deep sternal wound infection [DSWI]) in relation to patients with complete wound healing. Results: A total of 1118 patients met the inclusion criteria. The bivariate analysis demonstrated that the SSWI rate was significantly reduced by 43% in the GCCI group vs. standard treatment. Multivariate analysis demonstrated that addition of GCCI to standard treatment reduced the DSWI rate by 59% vs. standard treatment alone. Arterial hypertension, permanent/persistent atrial fibrillation and chest revision were identified as new risk factors for SSWI and pulmonary hypertension and chest revision were identified as new risk factors for DSWI. Discussion: This study confirms the positive results with GCCI seen in the majority of published studies in cardiac surgery. Conclusion: In routine clinical practice the addition of GCCI to standard infection prophylaxis reduces the risk of both SSWI and DSWI in high-risk patients undergoing cardiac surgery.