Ozan Onur BALKANAY, Gökhan İPEK, Deniz GÖKSEDEF, Suat Nail ÖMEROĞLU, Zeki KILIÇ, Safa GÖDE

Does locally administered gentamicin affect the incidence of sternal wound infections after coronary artery bypass graft surgery?

Amaç: Bu çalışmada koroner arter baypas greftleme (KABG)ameliyatında gentamisin emdirilmiş gaz kullanımının sternalyara yeri enfeksiyonuna (SYYE) karşı koruyucu etkisi olupolmadığı araştırıldı.Çalışmaplanı: Çift-kör ve plasebo kontrollü çalışmaya 100ardışık KABG hastası dahil edildi. Hastalar gentamisinve plasebo grupları olmak üzere iki gruba ayrıldı. Cerrahisırasında, gentamisin/izotonik solüsyon emdirilmiş gazlarsternum ekartörünün kenarlarının altına yerleştirildi. Primersonlanım noktaları SYYE gelişimi, yara revizyonu ve KABGsonrası ilk 30 gün içinde mortalite idi. İki grup istatistikselolarak karşılaştırıldı.Bul gu lar: Altı hastada SYYE gelişti. Bu hastaların üçündeetkilenme yüzeyeldi ve yara revizyonu gerekmedi. Diğerüç hastada hem ciltte hem de ciltaltı tabakalarda tutulumvardı ve bu hastaların tümünde revizyon gerekti. TümSYYE olguları plasebo grubundaydı ve gruplar arasındaanlamlı farklılık vardı (p=0.027). Hiçbir hastada mortalitegözlenmedi.Sonuç: Gentamisin ve plasebo grupları arasındaki istatistikselkarşılaştırma anlamlı bir farklılık gösterdi. Bu sonuç, lokalgentamisinli gaz kullanımının en az gentamisin-kollajen implantkullanımı kadar etkili olduğunu ortaya koydu. Dolayısıyla,KABG sırasında sternum ekartörü altına gentamisin emdirilmişgaz yerleştirilmesi SYYE oranlarının azaltılmasında faydalıolabilir.

Lokal gentamisin uygulaması koroner arter baypas greftleme ameliyatı sonrası sternal yara yeri enfeksiyonu insidansını etkiliyor mu?

Background: This study aims to investigate whether the use ofgentamicin-soaked sponges during coronary artery bypass graft(CABG) surgery has a protective effect against sternal woundinfection (SWI). Methods: We included 100 consecutive CABG patients ina double-blind and placebo controlled study. Patients wererandomized into two groups as gentamicin and placebo groups.During surgery, gentamicin/isotonic solution absorbed spongeswere placed beneath the edges of the sternum-retractor. Primaryend points were the development of SWI, wound revision, andmortality within the first 30 days after CABG. Two groups werecompared statistically. Results: Sternal wound infection developed in six patients. Theimpact in three patients was superficial, and no wound revisionwas required. In the other three patients, both cutaneous andsubcutaneous layers of the skin were involved, and they allneeded revision. All SWI cases were in the placebo group, andthere was a significant difference between the groups (p=0.027).No mortality was observed in any patient. Conclusion: The statistical comparison between gentamicinand placebo groups showed a significant difference. Thisresult revealed that local use of gentamicin-sponges can be atleast as effective as the use of gentamicin-collagen implants.Therefore, placing gentamicin-soaked sponges beneath thesternum-retractor during CABG can be beneficial to decreaseSWI rates.

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