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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
74
VOLUME 13 NUMBER 2 • DECEMBER 2016
The protective effect of topical rifamycin treatment against
sternal wound infection in diabetic patients undergoing
on-pump coronary artery bypass graft surgery
FATIH AYGUN, AHMET KUZGUN, SEREF ULUCAN, AHMET KESER, MAHMUT AKPEK, MEHMET G KAYA
Correspondence to: Seref Ulucan
Department of Cardiology, School of Medicine, Mevlana University, Konya,
Turkey
e-mail:
serefulucan@hotmail.comAhmet Keser
Department of Cardiology, School of Medicine, Mevlana University, Konya,
Turkey
Fatih Aygun, Ahmet Kuzgun
Department of Cardiovascular Surgery, School of Medicine, Mevlana
Iniversity, Konya, Turkey
Mahmut Akpek, Mehmet G Kaya
Department of Cardiology, School of Medicine, Erciyes University, Kayseri,
Turkey
Previously published in
Cardiovasc J Afr
2014;
27
: 96–99
S Afr J Diabetes Vasc Dis
2016;
13
: 74–76
Abstract
Objectives:
The aim of this study was to investigate the
protective effect of topical rifamycin SV treatment against
sternal wound infection (SWI) in diabetic patients undergoing
on-pump coronary artery bypass graft (CABG) surgery.
Methods:
One hundred and fifty-nine diabetic patients who
were scheduled to undergo isolated on-pump CABG surgery
were included. Eight were excluded for various reasons. Of
the 151 patients, 51 were on insulin therapy and 100 were
on oral anti-diabetics. The risk of mediastinitis was assessed
using the American College of Cardiology/American Heart
Association 2004 guideline update for CABG surgery.
According to the risk scores, patients were divided into two
comparable groups: the rifamycin group (
n
= 78) received
topical rifamycin treatment after on-pump CABG surgery, and
the control group (
n
= 73) received no topical treatment.
Results:
Deep sternal wound infection (mediastinitis) was
not observed in either group (0/78 vs 0/73,
p
= 1.0). No
superficial sternal wound infection was observed in the
rifamycin group, however, it did occur in one patient in
the control group (0/78 vs 1/73,
p
= 0.303). Wound culture
was performed and coagulase-negative staphylococci were
observed. The infection regressed on initiation of antibiotic
therapy against isolated bacteria and the patient was
discharged after a full recovery.
Conclusion:
Although the difference in rate of superficial
sternal wound infection (SSWI) in the rifamycin and control
groups was not statistically significant, locally applied
rifamycin SV during closure of the sternum in the CABG
operation may have had a protective affect against SWI.
Keywords:
rifamycin, sternal wound infection, on-pump CABG
Sternal wound infection (SWI) is a rare complication occurring
after coronary artery bypass graft (CABG) surgery. Sternal wound
infection occurs in one to 3% of patients and has a mortality rate
of up to 40%. It is also associated with prolonged hospital stay and
increased healthcare costs.
1-4
According to the American College of Cardiology/American
Heart Association (ACC/AHA) 2004 guideline update for CABG
surgery, the risk of mediastinitis is evaluated before CABG surgery
using factors, such as age of patient, the presence of obesity,
diabetes or chronic obstructive pulmonary disease (COPD), the need
for dialysis, an ejection fraction (EF) < 40%, and being scheduled
for emergency surgery.
5
In studies by Khanlari
et al
. and Kloos
et al
., patients with
SWI were divided into two subgroups: superficial sternal wound
infection (SSWI) and deep sternal wound infection (DSWI).
6,7
While
SSWI involves only subcutaneous tissue, DSWI is associated with
sternal osteomyelitis and sometimes with infected retrosternal
space (termed mediastinitis). These researchers reported that DSWI
occurred in 0.25 to 2.3% of patients.
6,7
Rifamycin SV is a relatively effective agent for the treatment of
gram-positive bacteria,
Mycobacterium tuberculosis
and certain
gram-negative bacteria. Rifampicin, derived from rifamycin SV, is
readily absorbed after oral administration and possesses higher
antimicrobial activity against
Staphylococcus aureus, S epidermidis,
Streptococcus viridans
and
Mycobacterium tuberculosis,
even
in very low doses. In nly one study in the literature has the use
of antibiotics containing rifampicin been suggested to improve
outcomes in staphylococcal deep-wound infections.
6
In the present study, we aimed to investigate the protective
effects of topical rifamycin SV treatment on SWI after on-pump
CABG surgery in diabetic patients.
Methods
One hundred and fifty-nine diabetic patients who were scheduled to
undergo isolated CABG surgery in the Department of Cardiovascular
Surgery, Mevlana University between July 2008 and July 2011 were
prospectively enrolled. Of these patients, eight were excluded due
to use of the intra-operative beating-heart technique, a need for
revision in the post-operative period, or death. In the remaining
151 patients, the risk of mediastinitis was assessed according to the
ACC/AHA 2004 guideline update for CABG surgery.
5
We grouped the patients according to their mediastinitis risk
scores into two comparable groups: the rifamycin group consisted
of 78 patients (52 male, mean age 62 ± 8 years) who received
local antibiotic rifamycin SV i.m. (Rif
®
250 mg/3-ml ampoule) on the
sternal region after CABG surgery, and the control group consisted