Role of Topical Application of Gentamicin Containing Collagen Implants in Cardiac Surgery

Sternal wound infections (SWI) continue to be a major cause of concern
after cardiac surgery. It leads to prolonged hospital stay and increased
morbidity, mortality and increased hospital costs. Prophylactic
systemic antibiotics have been used to prevent surgical site infection
(SSI). However, prolonged postoperative use of systemic antibiotics can
lead to emergence of resistant organisms. Gentamycin Containing Collagen
Implants (GCCI) when used during sternotomy closure produces high local
antibiotic concentrations in the wound with a low serum concentration.
There is evidence that the concentration of gentamicin in the
mediastinal fluid reaches levels high enough to be effective against
bacteria that are considered resistant to gentamycin and other
antibiotics.However, questions have been raised about the safety and
efficacy of GCCI. There were concerns whether GCCI can lead to systemic
absorption with renal impairment and whether use of topical antibiotics
can lead to emergence of antimicrobial resistance.We, hereby, review the
literature on GCCI (Collatamp) and take the opportunity to appraise the
scientific community about their role in cardiac surgery. Several
recent studies have supported their clinical effectiveness. They should
be used in dry condition and should not be soaked in saline even for a
short period prior to use. However, for GCCI to become part of routine
practice in cardiac surgery further large randomised studies are
required. As the incidence of sternal wound infection is low in the
specialty of cardiac surgery, for any study to be sufficiently powered
to address this issue, multicenter studies might be the way
forward.Based on the evidence presented in this manuscript it is
recommended GCCI (Collatamp) can be a cost effective adjunct for
prevention of sternal wound infection. They can also be used for
treatment of Deep Sternal Wound Infection.