CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 3, May/June 2014
96
AFRICA
Cardiovascular Topics
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
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 coag-
ulase-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 rifa-
mycin SV during closure of the sternum in the CABG opera-
tion may have had a protective affect against SWI.
Keywords:
rifamycin, sternal wound infection, on-pump CABG
Submitted 13/1/13, accepted 20/2/14
Cardiovasc J Afr
2014;
25
: 96–99
DOI: 10.5830/CVJA-2014-008
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 only 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
Department of Cardiovascular Surgery, School of
Medicine, Mevlana University, Konya, Turkey
Fatih Aygun, MD
Ahmet Kuzgun, MD
Department of Cardiology, School of Medicine, Mevlana
University, Konya, Turkey
Seref Ulucan, MD,
Ahmet Keser, MD
Department of Cardiology, School of Medicine, Erciyes
University, Kayseri, Turkey
Mahmut Akpek, MD
Mehmet G Kaya, MD
