Gentamicin In Cardiac Surgery

by / 4 Comments / 15 View / September 24, 2014

Role of topical application of gentamicin containing collagen implants in cardiac surgery

Sternal wound infections (SWI) continue to be a major cause of concern after cardiac surgery. It leads to prolonged
hospital stay and increased morbidity, mortality and increased hospital costs. Prophylactic systemic antibiotics have
been used to prevent surgical site infection (SSI). However, prolonged postoperative use of systemic antibiotics can
lead to emergence of resistant organisms. Gentamycin Containing Collagen Implants (GCCI) when used during
sternotomy closure produces high local antibiotic concentrations in the wound with a low serum concentration.
There is evidence that the concentration of gentamicin in the mediastinal fluid reaches levels high enough to be
effective against bacteria that are considered resistant to gentamycin and other antibiotics.
However, questions have been raised about the safety and efficacy of GCCI. There were concerns whether GCCI can
lead to systemic absorption with renal impairment and whether use of topical antibiotics can lead to emergence of
antimicrobial resistance.
We, hereby, review the literature on GCCI (Collatamp) and take the opportunity to appraise the scientific
community about their role in cardiac surgery. Several recent studies have supported their clinical effectiveness.
They should be used in dry condition and should not be soaked in saline even for a short period prior to use.
However, for GCCI to become part of routine practice in cardiac surgery further large randomised studies are
required. As the incidence of sternal wound infection is low in the specialty of cardiac surgery, for any study to be
sufficiently powered to address this issue, multicenter studies might be the way forward.
Based on the evidence presented in this manuscript it is recommended GCCI (Collatamp) can be a cost effective adjunct
for prevention of sternal wound infection. They can also be used for treatment of Deep Sternal Wound Infection.

For the full version of the article click here: Role of topical application of gentamicin containing collagen implants in cardiac surgery

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