Topical Application of Bacitracin Ointment Is Associated with Decreased Risk of Mediastinitis after Median Sternotomy

Authors

  • Robroy H. MacIver
  • Robert Stewart
  • James W. Frederiksen
  • David A. Fullerton
  • Keith A. Horvath

DOI:

https://doi.org/10.1532/HSF98.20051187

Abstract

Background. The diagnosis of mediastinitis after open-heart surgery is infrequent but dreaded as it carries a high morbidity and mortality. The purpose of this study was to investigate the impact that topical antibacterials would have on the postoperative mediastinitis rate.

Methods. Data were collected from 2455 consecutive patients who underwent sternotomy and cardiopulmonary bypass for both valvar and ischemic heart disease. Prior to 1999, patients (n = 1036) underwent surgery with standard perioperative intravenous antibiotics but no application of bacitracin. After 1999, patients (n = 1419) underwent surgery with intravenous antibiotics and application of bacitracin ointment to the sternotomy incision after closure.

Results. Cases of mediastinitis occurred in 12 patients (1.2%) not treated with bacitracin, which required re-exploration, sternectomy, and soft tissue closure of the mediastinum. Alternatively, 3 patients (0.2%) in the group treated with bacitracin developed mediastinitis (P < .01). Therefore, the use of topical antibacterials was associated with a 6-fold reduction in the risk of mediastinitis after cardiac surgery. This significant difference in the infection rate was observed even though the percentage of patients with risk factors for mediastinitis was equal to greater than the group not treated with bacitracin. Non-bacitracin versus bacitracin: diabetics, 298 versus 484; emergency operations, 24 versus 50; bilateral internal thoracic grafts, 28 versus 29; and obesity (body mass index >30), 294 versus 396.

Conclusions. The use of topical antibacterials is associated with a decrease in the risk of mediastinitis after cardiac surgery.

References

Antunes P, Bernardo JE, Eugenio L, et al. 1997. Mediastinitis after aorto-coronary bypass surgery. Eur J Cardiothorac Surg 12:443-9.nAsensio A, Guerrero A, Quereda C, et al. 1996. Colonization and infection with methicillin resistant Staphylococcus aureus: associated factors and eradication. Infect Control Hosp Epidemiol 17:20-8.nBencini PL, Galimberti M, Signorini M, et al. 1991. Antibiotic prophylaxis of wound infections in skin surgery. Arch Dermatol 127:1357-60.nBitkover C, Bardlund B. 1998. Mediastinitis after cardiovascular operations: a case-control study of risk factors. Ann Thorac Surg 65:36-40.nBorg MA. 2003. Bed occupancy and overcrowding as determinant factors in the incidence of MRSA infections within general ward settings. J Hosp Infect 54:316-8.nBreyer RH, Mills SA, Hudspeth AS, et al. 1984. A prospective study of sternal wound complications. Ann Thorac Surg 37:412-6.nCheung EH, Craver JM, Jones EL, et al. 1985. Mediastinitis after cardiac valve operations. Impact upon survival. J Thorac Cardiovasc Surg 90:517-22.nEl Gamel A, Yonan NA, Hassan R, et al. 1998. Treatment of mediastinitis: early modified robicsek closure and pectoralis major advancement flaps. Ann Thorac Surg 5:41-7.nFarinas MC, Peralta FG, Bernal JM, et al. 1995. Supparative mediastinitis after open-heart surgery: a case-control study covering a seven-year period in Santander, Spain. Clin Infect Dis 20:272-9.nGnanalingham KK, Elsaghier A, Kibbler C, et al. 2003. The impact of methicillin-resistant Staphyolococcus aureus in a neurosurgical unit: a growing problem. J Neurosurg 98:8-13.nGrossi E, Esposito R, Harris LJ, et al. 1991. Sternal wound infections and use of internal mammary artery grafts. J Cardiovasc Surg 102:342-7.nGruessner U, Clemens M, Pahlplatz PV, et al. 2001. Improvement of perineal wound healing by local administration of Gentamicin-impregnated collagen fleeces after abdominoperineal excision of rectal cancer. Amer J Surg 182:502-9.nIvert T, Lindblom D, Sahni J, et al. 1991. Management of deep sternal wound infection after cardiac surgery-Hanuman syndrome. Scand J Thorac Cardiovasc Surg 25:111-7.nIwakura A, Tabata Y, Miyao M, et al. 2000. Novel method to enhance sternal healing after harvesting bilateral internal thoracic arteries with use of basic fibroblast growth factor. Circulation 102:III307-11.nKaiser AB, Kernodle DS, Barg NL, et al. 1988. Influence of preoperative showers on Staphylococcal skin colonization: a comparative trial of antiseptic skin cleansers. Ann Thorac Surg 45:35-8.nKurz A, Sessler DI, Lenhardt R. 1996. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Eng J Med 334:1209-15.nLangford JH, Artemi P, Benrimoj S. 1997. Topical antimicrobial prophylaxis in minor wounds. Ann Pharmacother 31:559-63.nLau WY, Fan ST, Chu KW, et al. 1986. Combined topical povidoniodine and systemic antiboitics in post-appendicetomy wound sepsis. Brit J Surg 73:958-60.nLoop F, Lytle BW, Cosgrove DM, et al. 1990. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg 49:179-87.nMack RM, Cantrell JR. 1967. Quantitative studies of the bacterial flora of open skin wounds: the effect of topical antibiotics. Ann Surg 166:886-95.nMilano CA, Kesler K, Archibald N, et al. 1995. Mediastinitis after coronary artery bypass graft surgery. Risk factors and long-term survival. Circulation 92:2245-51.nMing LJ, Epperson JD. 2002. Metal binding and structure-activity relationship of the metalloantibiotic peptide bacitracin. J Inorganic Biochem 91:46-58.nNishida H, Grooters RK, Merkley DF, et al. 1990. Postoperative mediastinitis: a comparison of two electrocautery techniques on presternal soft tissues. J Thorac Cardiovas Surg 99:969-76.nOakley RM, Wright JE. 1996. Post-operative mediastinitis: classification and management. Ann Thorac Surg 61:1030-6.nPitt HA, Postier RG, Gadacz TR, et al. 1982. The role of topical antibiotics in "high-risk" biliary surgery. Surgery 91:518-24.nRidderstolpe L, Gill H, Granfeldt H, et al. 2001. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 20:1168-75.nRisnes I, Abdelnoor M, Baksaas ST, et al. 2001. Sternal wound infections in patients undergoing open heart surgery: randomized study comparing intracutaneous and transcutaneous suture techniques. Ann Thorac Surg 72:1587-91.nSethi GK, Copeland JG, Moritz T, et al. 1991. Comparison of postoperative complications between saphenous vein and IMA grafts to left anterior descending coronary artery. Ann Thorac Surg 51:733-8.nSmack DP, Harrington AC, Dunn C, et al. 1996. Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs. bacitracin ointment. A randomized controlled trial. JAMA 276:972-7.nSofer D, Gurevitch J, Shapira I, et al. 1999. Sternal wound infections in patients after coronary artery bypass grafting using bilateral skeletonized internal mammary arteries. Ann Surg 229:585-90.nSpann CT, Tutrone WD, Weinberg JM, et al. 2003. Topical antibacterial agents for wound care: a primer. Dermatolog Surg 29:620.nSuntharam N, Lankford MG, Trick WE, et al. 2002. Risk factors for acquisition of vancomycin-resistant enterococci among hematology-oncology patients. Diag Microbiol Infect Dis 43:183-8.nTroy M, Dong Q, Dobrin P, et al. 1996. Do topical antibiotics provide improved prophylaxis against bacterial growth in the presence of polypropylene mesh? Amer J Surg 171:391-3.nVan Domburg RT, Takkenberg JJ, Meeter K, et al. 2002. Coronary bypass surgery in 1971-80 and 1995-96: increased age and comorbidity, unchanged survival rates and fewer early re-operations 1 and 5 years postoperatively. Ned Tijdschr Geneeskd 146:2192-6.nWalker WS, Raychaudhury T, Faichney A, et al. 1986. Wound colonization following cardiac surgery. Reduction by adjuvant use of preincisional, presternal antibiotic infiltration: a double blind prospective randomized study. J Cardiovasc Surg 27:662-6.nWouters R, Wellens F, Vanermen H, et al. 1994. Sternitis and mediastinitis after coronary artery bypass grafting. Analysis of risk factors. Tex Heart Inst J 21:183-8.nZacharias A, Habib RH. 1996. Factors predisposing to median sternotomy complications. Deep vs. superficial infection. Chest 110:1173-8.n

Published

2006-07-05

How to Cite

MacIver, R. H., Stewart, R., Frederiksen, J. W., Fullerton, D. A., & Horvath, K. A. (2006). Topical Application of Bacitracin Ointment Is Associated with Decreased Risk of Mediastinitis after Median Sternotomy. The Heart Surgery Forum, 9(5), E750-E753. https://doi.org/10.1532/HSF98.20051187

Issue

Section

Article