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Implantable antibiotic sponges reduce sternal infections after cardiac surgery
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The use of implantable gentamicin-collagen sponges reduced the risk for sternal wound infection after cardiac surgery in a new meta-analysis.
According to the study background, the SWIPE-1 trial found no additional benefit associated with implantable gentamicin-collagen sponges in high-risk patients undergoing cardiac surgery.
The researchers undertook a meta-analysis of the efficacy of implantable gentamicin-collagen sponges after heart surgery, incorporating four randomized controlled trials and 10 observational studies (n = 22,135). The primary endpoint was sternal wound infection. Secondary endpoints included deep sternal wound infection, superficial sternal wound infection, mediastinitis and mortality.
Mariusz Kowalewski, MD, and colleagues observed a 40% reduction in risk for sternal wound infection with the use of implantable gentamicin-collagen sponges compared with controls in both randomized trials (RR = 0.61; 95% CI, 0.39-0.98) and observational studies (RR = 0.61; 95% CI, 0.42-0.89). Pooled results across both study types yielded an RR of 0.62 (95% CI, 0.47-0.81).
Kowalewski, from the department of cardiac surgery, Dr. Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland, and colleagues found a similar benefit associated with the sponges for deep sternal wound infection (RR = 0.62; 95% CI, 0.44-0.87), superficial sternal wound infection (RR = 0.6; 95% CI, 0.43-0.83) and mediastinitis (RR = 0.64; 95% CI, 0.45-0.91) in overall analysis. They observed no effect on mortality risk.
The researchers also noted a positive linear correlation between the log risk ratio of both deep and superficial sternal wound infection and the percentage of patients who received bilateral internal thoracic artery grafts (P = .05).
Harold L. Lazar
In a related editorial, Harold L. Lazar, MD, from the division of cardiac surgery at Boston Medical Center, wrote that the SWIPE-1 results “may have been due to a failure … to follow the manufacturer’s sponge implantation protocol, which resulted in longer exposure of the gentamicin sponge in a saline solution before application, thus lowering the concentration of gentamicin in the sponge.”
Based on the results of the meta-analysis and other literature, Lazar wrote, “Strong consideration should be given to using some form of topical antibiotics in all cardiac surgical patients undergoing median sternotomy.” – by Erik Swain
Disclosure: The researchers and Lazar report no relevant financial disclosures.
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