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  • Relation between topical application of platelet-rich plasma and vancomycin and severe deep sternal wound infections after a first median sternotomy.

Relation between topical application of platelet-rich plasma and vancomycin and severe deep sternal wound infections after a first median sternotomy.

The American journal of cardiology (2014-03-01)
Baron L Hamman, Laura Y Stout, Theodore T Theologes, Danielle M Sass, Briget da Graca, Giovanni Filardo
ABSTRACT

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.

MATERIALS
Product Number
Brand
Product Description

Vancomycin hydrochloride, European Pharmacopoeia (EP) Reference Standard
Sigma-Aldrich
Vancomycin hydrochloride from Streptomyces orientalis, ≥85% (Vancomycin B)
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Vancomycin hydrochloride from Streptomyces orientalis, BioReagent, suitable for plant cell culture
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Vancomycin hydrochloride from Streptomyces orientalis, ≥900 μg per mg (as vancomycin base)
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Vancomycin hydrochloride from Streptomyces orientalis, meets USP testing specifications
Millipore
Vancomycin supplement, suitable for microbiology