Relation Between Topical Application of Platelet-Rich Plasma and Vancomycin and Severe Deep Sternal Wound Infections After a First Median Sternotomy

• Published in: The American journal of cardiology 2014-04, Vol.113 (8), p.1415-1419
• Main Authors: Hamman, Baron L., MD, Stout, Laura Y., BBA, Theologes, Theodore T., MS, PA-C, Sass, Danielle M., MPH, CPH, da Graca, Briget, JD, MS, Filardo, Giovanni, PhD, MPH
• Format: Article
• Language: English
• Subjects: Administration, Topical; Anti-Bacterial Agents - administration & dosage; Antibiotics; Blood platelets; Cardiology; Cardiovascular; Coronary vessels; Diabetes; Female; Follow-Up Studies; Heart attacks; Heart failure; Heart surgery; Hospital costs; Humans; Hypertension; Incidence; Infections; Logistics; Lung diseases; Male; Middle Aged; Mortality; Plasma; Platelet-Rich Plasma; Retrospective Studies; Severity of Illness Index; Sternotomy - adverse effects; Surgical Wound Infection - epidemiology; Surgical Wound Infection - therapy; Texas - epidemiology; Treatment Outcome; Vancomycin - administration & dosage; Veins & arteries; Wound Healing
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.12.046

Deep sternal wound infections (DSWIs) are serious complications of sternotomy, leading to increased mortality and costs of care. Topical applications of autologous platelet concentrate and vancomycin have both shown promise in preventing DSWIs. From January 1, 1998, to November 30, 2010, 1,866 patients without previous sternotomy underwent cardiac surgery at the Baylor University Medical Center, Dallas, by a single surgeon who systematically adopted application of a paste containing vancomycin, calcium-thrombin, and platelet-rich plasma (PRP paste) to the edges of sternal wounds before closure in December 2005. A propensity-adjusted logistic regression model employing Firth's penalized maximum likelihood method was used to assess the association between the use of the PRP paste (intervention) and the incidence of severe DSWI. Eleven patients (0.59%) developed severe DSWIs. All were among the 1,318 patients in the control group (0.83%); no severe DSWIs developed in the 548 patients in the intervention group. Both the unadjusted and adjusted associations between the study intervention and DSWI were statistically significant (unadjusted p value = 0.021; adjusted p value = 0.005; adjusted odds ratio = 0.05, 95% confidence interval 0.01, 0.50). In conclusion, the PRP paste appears to prevent severe DSWIs.