Topical Vancomycin in Prevention of Methicillin-Resistant Staphylococcal Related Mediastinitis in Patients Receiving Coronary Artery Bypass Graft

Background Postoperative sterno-mediastinitis is a life-threatening complication. Although the incidence rate is about 0.75 to 1.4% in all open heart operations, the association with morbidity, mortality and cost is unacceptably high (1, 2). Some risk factors should be minimized as possible, such as preoperative days in the hospital, and poor controlled blood sugar and other chronic underlying conditions. In addition, patients should shower the night and morning before surgery with chlorhexadine and remove hair with clipper or depilatory crème instead of a shave. These basic rules of sterile technique can't be emphasized enough and may reduce the occurrence of postoperative sterno-mediastinitis form 7.5 to 0.8% (3, 4).

The matter of prophylactic antibiotics is controversial. Although everybody agrees the necessity of using prophylactic antibiotics but which to use and how long it should be administered remain a debate. The most commonly occurring bacterial offenders in the institution always should be considered in selecting of prophylactic antibiotics.

Staphylococcus spp. is most common pathogens in most institutions and also in our hospitals. It is currently recommended that the use of vancomycin for perioperative prophylaxis should be considered only in patients with a life-threatening allergy toβ-lactam antibiotics or at institutions with a high rate of infections caused by MRSA or methicillin-resistant S. epidermidis (5). However, the relative low concentration of vancomycin in sternal bone was noted when given intravenously (5). According to the study performed by Vander et al. in 1989, we also try to apply vancomycin over the cut sternal edges in patients receiving CABG (coronary artery bypassing graft) and to evaluate the effect on reducing the infection of staphylococcus related mediastinitis (6). In addition, we try to observe that prophylactic use of topical vancomycin will increase the risk for acquiring resistant pathogen such as VISA (vancomycin-intermediate S. aureus), VRSA (Vancomycin-resistant S. aureus), VRE (vancomycin-resistant enterococcus).

Aim We try to apply vancomycin over the cut sternal edges in patients receiving CABG (coronary artery bypassing graft) and to evaluate the effect on reducing the infection of staphylococcus related mediastinitis. In addition, we try to observe the use of topical vancomycin will induce the collateral effect on increasing the infections of resistant pathogen such as VISA (vancomycin-intermediate S. aureus), VRSA (Vancomycin-resistant S. aureus), VRE (vancomycin-resistant enterococcus) or other infections caused by GNB or yeast.

Materials and methods