Effectiveness of Gentamicin–Collagen Sponges in Preventing Sternal Wound Infections

Abstract

Background

This study aimed to evaluate whether the combined use of gentamicin–collagen sponges and topical vancomycin reduces the incidence of sternal wound infections (SWIs) in patients at high risk for infection following cardiac surgery.

Methods

A single-center, retrospective study compared two groups of high-risk cardiac surgery patients from June 2018 to September 2021. High-risk patients, identified through departmental consensus, had multiple SWI risk factors. The study group (278 patients) received gentamicin–collagen sponges plus topical vancomycin, whereas the control group (309 patients) received only topical vancomycin. The primary outcome was SWI incidence.

Results

The incidence of SWI was significantly lower in the study group, with 2.8% (8/278) compared with 9% (28/309) in the control group (p = 0.002). After adjusting for known risk factors, the odds of infection in the control group were 4.64 times higher (95% confidence interval [CI]: 1.63–13.21) than in the study group. The rate of deep sternal wound infections (DSWI) was 1.8% in the study group versus 4.2% in the control group (p = 0.09), with adjusted odds of DSWI being 4.1 times higher in the control group (95% CI: 0.99–16.86). Although the p-value was borderline (p = 0.05), no significant differences in mortality rates were observed between the two groups.

Conclusion

The use of gentamicin–collagen sponges as part of a prophylactic regimen significantly reduces the incidence of SWI in high-risk cardiac surgery patients, suggesting its potential benefit as an adjunctive treatment in preventing postoperative infections.

Keywords

gentamicin–collagen sponges - gentamicin-containing collagen implants - topical vancomycin - surgical site infection - sternal wound infection - deep sternal wound infection

Data Availability Statement

The data underlying this article will be shared on reasonable request to the corresponding author.

Publication History

Received: 05 March 2025

Accepted: 09 June 2025

Accepted Manuscript online:
16 June 2025

Article published online:
25 June 2025

• References

• 1 Losanoff JE, Collier AD, Wagner-Mann CC. et al. Biomechanical comparison of median sternotomy closures. Ann Thorac Surg 2004; 77 (01) 203-209
• 2 Losanoff JE, Richman BW, Jones JW. Disruption and infection of median sternotomy: a comprehensive review. Eur J Cardiothorac Surg 2002; 21 (05) 831-839
• 3 Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 2001; 20 (06) 1168-1175
• 4 Sharma R, Puri D, Panigrahi BP, Virdi IS. A modified parasternal wire technique for prevention and treatment of sternal dehiscence. Ann Thorac Surg 2004; 77 (01) 210-213
• 5 Kiessling AH, Isgro F, Weisse U, Möltner A, Saggau W, Boldt J. Advanced sternal closure to prevent dehiscence in obese patients. Ann Thorac Surg 2005; 80 (04) 1537-1539
• 6 Jidéus L, Liss A, Ståhle E. Patients with sternal wound infection after cardiac surgery do not improve their quality of life. Scand Cardiovasc J 2009; 43 (03) 194-200
• 7 Sears ED, Wu L, Waljee JF, Momoh AO, Zhong L, Chung KC. The impact of deep sternal wound infection on mortality and resource utilization: a population-based study. World J Surg 2016; 40 (11) 2673-2680
• 8 Blüher M, Brandt D, Lankiewicz J, Mallow PJ, Saunders R. Economic analysis of the European Healthcare burden of sternal-wound infections following coronary artery bypass graft. Front Public Health 2020; 8: 557555
• 9 Engelman R, Shahian D, Shemin R. et al; Workforce on Evidence-Based Medicine, Society of Thoracic Surgeons. The Society of Thoracic Surgeons practice guideline series: antibiotic prophylaxis in cardiac surgery, part II: antibiotic choice. Ann Thorac Surg 2007; 83 (04) 1569-1576
• 10 Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S. Prevention and management of sternal wound infections. J Thorac Cardiovasc Surg 2016; 152 (04) 962-972
• 11 Sousa-Uva M, Head SJ, Milojevic M. et al. 2017 EACTS guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg 2018; 53 (01) 5-33
• 12 Hernandez R, Lehr EJ. Mortality following deep sternal wound infection-not just a short-term complication?. Eur J Cardiothorac Surg 2021; 60 (02) 242-243
• 13 Phoon PHY, Hwang NC. Deep sternal wound infection: diagnosis, treatment and prevention. J Cardiothorac Vasc Anesth 2020; 34 (06) 1602-1613
• 14 Friberg O, Svedjeholm R, Söderquist B, Granfeldt H, Vikerfors T, Källman J. Local gentamicin reduces sternal wound infections after cardiac surgery: a randomized controlled trial. Ann Thorac Surg 2005; 79 (01) 153-161 , discussion 161–162
• 15 Friberg O, Dahlin LG, Källman J, Kihlström E, Söderquist B, Svedjeholm R. Collagen-gentamicin implant for prevention of sternal wound infection; long-term follow-up of effectiveness. Interact Cardiovasc Thorac Surg 2009; 9 (03) 454-458
• 16 Mishra PK, Ashoub A, Salhiyyah K. et al. Role of topical application of gentamicin containing collagen implants in cardiac surgery. J Cardiothorac Surg 2014; 9: 122
• 17 Lazar HL, Ketchedjian A, Haime M, Karlson K, Cabral H. Topical vancomycin in combination with perioperative antibiotics and tight glycemic control helps to eliminate sternal wound infections. J Thorac Cardiovasc Surg 2014; 148 (03) 1035-1038 , 1038–1040
• 18 Lazar HL, Barlam T, Cabral H. The effect of topical vancomycin applied to sternotomy incisions on postoperative serum vancomycin levels. J Card Surg 2011; 26 (05) 461-465
• 19 Donovan TJ, Sino S, Paraforos A, Leick J, Friedrich I. Topical vancomycin reduces the incidence of deep sternal wound complications after sternotomy. Ann Thorac Surg 2022; 114 (02) 511-518
• 20 Andreas M, Muckenhuber M, Hutschala D. et al. Direct sternal administration of vancomycin and gentamicin during closure prevents wound infection. Interact Cardiovasc Thorac Surg 2017; 25 (01) 6-11
• 21 Schimmer C, Özkur M, Sinha B. et al. Gentamicin-collagen sponge reduces sternal wound complications after heart surgery: a controlled, prospectively randomized, double-blind study. J Thorac Cardiovasc Surg 2012; 143 (01) 194-200