Gentamicin Collagen Sponges for the Prevention of Sternal Wound Infection: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE:

The study objective was to determine whether the application of gentamicin collagen sponges reduces sternal wound infections in patients undergoing cardiac surgery.

METHODS:

A meta-analysis of randomized controlled trials was performed.

RESULTS:

Four randomized controlled trials were eligible for inclusion. By pooling data from 4 randomized controlled trials (4672 per-protocol patients), gentamicin collagen sponges reduced deep sternal wound infections (risk ratio, 0.62; 95% confidence interval, 0.39-0.97) and any sternal wound infections (risk ratio, 0.61; confidence interval, 0.39-0.98). In contrast, no benefit was demonstrated regarding superficial sternal wound infections (4 randomized controlled trials [4672 patients]; risk ratio, 0.65; 95% confidence interval, 0.34-1.25) and all-cause mortality (3 randomized controlled trials [3994 patients]; risk ratio, 0.90; 95% confidence interval, 0.57-1.42). On the basis of data from 2 randomized controlled trials (3410 patients), gentamicin collagen sponges also seemed to reduce surgically treated sternal wound infections (risk ratio, 0.59; 95% confidence interval, 0.41-0.86). The most commonly isolated pathogens were coagulase-negative Staphylococcus spp (43%) and Staphylococcus aureus (28%).

CONCLUSIONS:

Gentamicin collagen sponges seem to reduce the sternal wound infection rate in patients undergoing cardiac surgery. The statistical heterogeneity among the existing trials underlines the need for additional large, high-quality randomized controlled trials.