Sutureless circumcision; gentamicin-collagen implants; gentamicin prophylaxis; benefits of smoking cessation

AORN Journal,  May, 2005  by George Allen

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January 2005

The administration of IV antimicrobial prophylaxis before incision has documented efficacy in reducing the potential for the development of surgical site infections after cardiac surgery. Antimicrobial prophylaxis generally is accomplished using cephalosporin or penicillin; however, coagulase-negative staphylococci, which are resistant to these antimicrobial agents, are emerging as the most common pathogen in surgical wound infections. Alternative approaches to preventing surgical wound infections, therefore, must be considered. The objective of this randomized, prospective, double-blinded study was to determine whether locally administered gentamicin in addition to routine IV prophylaxis with isoxazolyl penicillin could reduce the incidence of postoperative surgical wound infections after cardiac surgery. (3)

From October 2000 through August 2002, patients undergoing cardiac surgery through median sternotomy at two cardiothoracic centers in Sweden were randomly assigned to one of two groups. Participants in the treatment group (n = 983) received IV prophylaxis with isoxazolyl penicillin and sternal application of a 10 cm by 10 cm by 0.5 cm gentamicin-collagen sponge that contained 130 mg gentamicin and 280 mg collagen beneath the sternum before the incision was closed. Participants in the control group (n = 967) received only IV prophylaxis with isoxazolyl penicillin. The incision was closed in a routine manner without the gentamicin-collagen sponge.

Postoperatively, patients were assessed daily for surgical wound infection and serum creatine levels. After discharge, patients were assessed for the development of surgical wound infections. They were contacted by telephone two months postoperatively and asked to answer a structured list of standardized questions. Any reported symptoms of impaired wound healing or possible wound infection resulted in a review of the medical records from all postoperative contacts with medical services. Common statistical techniques were used to analyze differences between the two groups.

Findings. One hundred twenty-nine surgical wound infections were recorded. Significantly fewer patients in the treatment group received antibiotics or needed surgical revision of the sternal wound during the follow-up. Patients in the control group were significantly more likely to develop surgical site infection (9% versus 4.3%, relative risk 0.47, 95% confidence interval 0.33-0.68, P < .001). Twenty-four of the 129 surgical wound infections (ie, 17 in the control group and seven in the treatment group) were diagnosed before the patients were discharged. There were no cases of verified or suspected allergic or adverse reactions to gentamicin or collagen.

Clinical implications. This study found that the use of a gentamicin-collagen sponge underneath the sternum before the incision was closed was safe and was associated with a significantly lower incidence of surgical wound infection after cardiac surgery. Perioperative nurses should assess patients for gentamicin and collagen allergies when gentamicin-collagen sponges are scheduled to be used before the incision is closed.