The use of vancomycin as an effective element in mediastinitis prophylaxis

Abstract

Introduction. Deep sternal wound infection remains a significant hazard for cardiosurgical patients undergoing median sternotomy. Although the prophylactic use of topical vancomycin to reduce the incidence of deep sternal wound complications (DSWC) has been repeatedly examined, the method remains controversial. Aim of study. Sternal mediastinitis is known as a complication of a postoperative infection especially after cardiac surgery. Analyzing international data on this serious complication, its morbidity varies between 0.15% and 2.5%, with mortality varying between 5 and 45% in different patient groups. Using different prevention methods is the objective. Methods and materials. In the period of 2015– 2021 years in Medpark International Hospital more than 2000 patients had open-heart surgery. From 2015, for 98% of patients (in exception of patients with allergy) was used the method of sternal interior surfaces impregnation (post-sternotomy) with Vancomycin 1,5 gr powder, applied 2 times: before the pericardiotomy and upstream of sternal suturing, via the topical techniques. Results. The rate of postsurgical complications with deep sternal wound infection in our Hospital was about 2% (N18). After starting using Vancomycin in 2015 there were no postoperative infections, deep sternal infections were not registered, reducing the cases up to 70% the number of superficial infections Conclusion. The results are soothing, because after 2015 when this method is used Vancomycin 1.5 gr powder forming a homogeneous paste with 1 ml NaCl solution, applied 2 times: before pericardiotomy and upstream of sternal suturing The hazard of deep mediastinal complications is evidently reduced due to the surgical management optimized in correlation with the impregnation of powder. It is necessary to continue detailed study with the identification of the optimal formula of application.