Vancomycin Local application, role in Deep Sternal Wound Infection in our experience

Document Type : Original Article


Cardiothoracic Surgeon, Department of Cardiothoracic Surgery, LTMGH and LTMMC, Sion, Mumbai-400022


Introduction: Deep sternal wound infection (DSWI) is one of the most complex and potentially devastating complications following median sternotomy in cardiac surgery. Despite many advances in prevention, it still remains significant and ranges between 0.5% and 6.8%. We aim to study the role of vancomycin paste applied locally over sternal edges in reducing DSWI.

Materials and Methods: We retrospectively collected data of patients who underwent open heart surgery from June 2017 to May 2019 in our institution. The rate of DSWI was compared in patients in whom vancomycin paste was applied and not applied. Vancomycin paste was prepared using 3 g of vancomycin with 4ml 0.9% normal saline and stirred until a ‘paste’ was formed. This vancomycin paste was applied just after sternotomy and at the time of sternal closure. The rate of DSWI was compared also compared in the following high risk sub groups: female patients, diabetes mellitus (DM), morbidly obese (Body Mass Index i.e. BMI>30) and chronic obstructive lung diseases (COPD).

Results: A total of 862 patients underwent open heart surgery during the specified period. Overall incidence of DSWI in our study was 3.48 %. DSWI was found to be significantly lower in vancomycin group (adjusted Odds ratio 2.116 and p=30) patients. These results need to be substantiated in randomized controlled trials and multiple centers.


1. Schimmer C, Özkur M, Sinha B, Hain J, Gorski A, Hager B, etal. Gentamicin-collagen sponge reduces sternal wound complications after heart surgery: a controlled, prospectively randomized, double-blind study. The Journal of thoracic and cardiovascular surgery. 2012 Jan 1;143(1):194-200.
2. Singh K, Anderson E, Harper JG. Overview and Management of SternalWound Infection. Seminars in Plastic Surgery 2011; 25: 25-33.
3. Filsoufi F, Castillo JG, Rahmanian PB, Broumand SR, Silvay G,Carpentier A, Adams DH. Epidemiology of deep sternal wound Infection in cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 2009; 23:488-494 [PMID: 19376733 DOI: 10.1053/j.jvca.2009.02.007]
4. Dodds Ashley ES, Carroll DN, Engemann JJ, Harris AD, Fowler VG et al. Risk factors for postoperativemediastinitis due to methicillin-resistant Staphylococcus aureus.Clin Infect Dis 2004; 38: 1555-1560 [PMID: 15156442 DOI:10.1086/420819]
5. Alhan C, Arıtürk C, Senay S, Okten M, Güllü AU, Kilic L, etal . Use of bone wax is related to increased postoperative sternal dehiscence. Kardiochirurgia i torakochirurgia polska= Polish journal of cardio-thoracic surgery. 2014 Dec; 11(4):385.
6. Lazar HL, Ketchedjian A, Haime M, Karlson K, Cabral H. Topical vancomycinin combination with perioperative antibiotics and tight glycemiccontrol helps to eliminate sternal wound infections. J ThoracicCardiovascular Surgery 2014; 148:1035–8; 1038–40.
7. Andreas M, Muckenhuber M, Hutschala D, Kocher A, Thalhammer F, Vogt P, Fleck T, Laufer G. Direct sternal administration of Vancomycin and Gentamicin during closure prevents wound infection. Interactive cardiovascular and thoracic surgery. 2017 Jul 1;25(1):6-11.
8. Gummert JF, Barten MJ, Hans C, Kluge M, Doll N, et al. Mediastinitisand cardiac surgery--an updated risk factor analysis in 10,373consecutive adult patients. ThoracicCardiovascular Surgery 2002; 50:87-91 [PMID: 11981708 DOI: 10.1055/s-2002-26691]
9. Vander Salm T, Okike ON, Pasque MK, et al. Reduction ofsternal infection by application of topical vancomycin.J ThoracicCardiovascular Surgery 1989;98:618–22.
10. Arruda MVF, Braile DM, Joaquim H, et al. Vancomycin paste for sternal hemostasis and mediastinitis prophylaxis. Rev BrasCirc Cardiovasc 2008; 23:35–9.
11. Harold L. Lazar, MD, Thomas Vander Salm, MD, et al. Prevention and management of sternal wound infections. The Journal of Thoracic and Cardiovascular Surgery, Vol. 152, Issue 4, p962–972 Published online: August 8, 2016