Local Application of Collagen-Gentamicin in Addition to Fixation of the Sternum With Extra Sternal Wires for Prevention of Sternal Wound Infection in Cardiac Surgery
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 1,358
- 试验地点
- 2
- 主要终点
- The incidences of methicillin- and gentamicin resistant microbiological agents in sternal wound infections that develop in study patients
研究概览
简要总结
The aim of the present study is to evaluate a new technique for prevention of sternal wound infection consisting of local application of collagen-gentamicin in addition to routine i.v. antibiotic prophylaxis.
The technique has been evaluated in a previous randomised study. The aim of the present study is to evaluate the technique after it has been introduced in clinical practise to monitor the bacterial antibiotic susceptibility and to verify that the suggested reduction in sternal wound infection still exits.
详细描述
A new technique for prevention of sternal wound infections after cardiac surgery is studied. Local application directly in the surgical wound of aminoglycoside antibiotics (gentamicin) bound to collagen reduced the incidence of wound infection with more than 50 % in a previous prospective randomised trial.
As the technique has been introduced in clinical practise two questions need to be monitored:
- Are there signs of change in the bacteria that cause the wound infections with a shift over time towards more gentamicin resistant agents?
- Is the effect of the prophylaxis still comparable to that which was seen in the previous study?
Furthermore, results from the previous study indicated that the effect of the local antibiotic was better when combined with an extra rigid sternal wound infection, defined as at least one extra steel wire for sternal fixation.
The study is conducted at those two Swedish cardiothoracic surgery centers where it was first studied. There are thus two objectives of the study: first to analyze the microbiologic findings of the sternal wound infections that occur, and secondly to monitor the incidence of sternal wound infection (especially deep infections) when the local collagen-gentamicin prophylaxis is used in daily routine in combination with a specific surgical technique for optimization of the strength of sternal fixation.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Single Group
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All consecutive cardiac surgery patients operated via median sternotomy
排除标准
- •Existing inclusion of the patient in another study of treatment aimed at reducing postoperative SWI.
- •Known allergy or other contraindication to gentamicin or bovine collagen.
- •Pregnancy or breast feeding
- •Treatment with aminoglycosides during the last week
研究组 & 干预措施
treatment
Use of local CollagenGentamicin and enhanced sternal fixation according to the Clinical routine introduced 4 years earlier as a result of a previous RCT on 2000 patients. In that sense these patients did not receive any intervention but just the standard treatment introduced 4 years earlier.
The aim of the study was to PROSPECTIVELY include a defined number of patients to compare their complication rate with that from aControl Group of patients från a previous RCT to verify that the effect of the treatment was stable over time.
As the study did not include any intervention compared to the present standard treatment at that time ethical approval was Exempt.
干预措施: Local application of collagen-gentamicin (Drug)
treatment
Use of local CollagenGentamicin and enhanced sternal fixation according to the Clinical routine introduced 4 years earlier as a result of a previous RCT on 2000 patients. In that sense these patients did not receive any intervention but just the standard treatment introduced 4 years earlier.
The aim of the study was to PROSPECTIVELY include a defined number of patients to compare their complication rate with that from aControl Group of patients från a previous RCT to verify that the effect of the treatment was stable over time.
As the study did not include any intervention compared to the present standard treatment at that time ethical approval was Exempt.
干预措施: Fixation of the sternotomy with more than six wires (Procedure)
结局指标
主要结局
The incidences of methicillin- and gentamicin resistant microbiological agents in sternal wound infections that develop in study patients
时间窗: Within 2 months postoperatively
次要结局
- The absolute incidence of all SWI and of superficial SWI within 2 months and the relative (the ratio) incidences of superficial vs deep SW(2 months postoperatively)
- The total incidence of SWI that requires surgical revision of the wound(2 months postoperatively)
研究者
Orjan Friberg
MD, PhD
Region Örebro County