Abstract
Impact of topical vancomycin paste on prevention of deep sternal wound infection in patients undergoing bilateral internal thoracic artery coronary bypass grafting
- Department of Cardiac Surgery, Zbigniew Religa Heart Center “Medinet”, Nowa Sol, Poland
- Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland
- Department of Cardiac Surgery, Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
- Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
- Department of Cardiac Surgery, J. Strus Hospital, Poznan, Poland
- Faculty of Health Sciences, University of Medical Sciences, Poznan, Poland
Introduction
Deep sternal wound infection (DSWI) remains a serious complication of coronary artery bypass grafting (CABG), particularly when bilateral internal thoracic arteries (BITA) are used. Concerns regarding DSWI often limit the adoption of multiple arterial grafting.
Aim
To evaluate the effect of topical vancomycin paste on the incidence of DSWI in patients undergoing primary isolated CABG with BITA.
Material and methods
This multicenter, retrospective study analyzed 1,694 patients who underwent BITA grafting between 2006 and 2024. Patients were stratified based on whether topical vancomycin paste was applied to the sternal edges (n = 455) or not (n = 1,239). Propensity score matching was used to account for baseline differences, generating 368 matched pairs. Odds ratios (ORs) were estimated using multivariable and conditional logistic regression.
Results
Multivariable logistic regression demonstrated that the use of topical vancomycin paste was independently associated with a 63% reduction in DSWI (OR = 0.37; 95% CI: 0.14–0.97; p = 0.045). Other independent predictors of increased DSWI risk included age ≥ 60 years, obesity, chronic lung disease, insulin therapy, female sex, and heart failure symptoms. After propensity score matching, 368 well-balanced pairs were obtained. In this matched cohort, topical vancomycin paste was associated with a substantial reduction in DSWI (OR = 0.17; 95% CI: 0.05–0.60; p = 0.001).
Conclusions
Topical application of vancomycin paste significantly reduces the risk of DSWI in patients undergoing CABG with BITA. This simple and effective prophylactic measure may help enable safer and broader adoption of multiple arterial grafting strategies.
>Keywords
coronary artery bypass, vancomycin, deep sternal wound infection, bilateral internal thoracic arteries
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