Use of Antibiotics in Reconstruction with Sternal Rigid Plate Fixation

Author(s):
Alexandra Blake; Vineet Mehan

Background:

Sternal infection is a serious complication after cardiac surgeries. Patients with infection have increased 1-year mortality and average hospital stays. While antibiotics have their place in infection prevention, abuse and eventual resistance are still a major concern. If a patient does not already have an infection, the recommendation is for no more than 48 hours of prophylactic antibiotics. The purpose of this study is to examine the effects of antibiotic use and their association with post-reconstruction infection, specifically in patients who did not previously have infection.

Hypothesis:

We hypothesized that duration of antibiotics makes no difference in the development of post-reconstruction infection.

Methods:

This is a retrospective study of patients who underwent sternal rigid plate fixation (SRPF) by a single plastic surgeon from April 2013 to January 2022. We evaluated different characteristics of antibiotic usage in patients who received SRPF, including duration of antibiotics, use of main antibiotic classes, number of antibiotics and antibiotic classes used, as well as wound culture results, along with characteristics related to infection status both before and after reconstruction. Inclusion criteria- sternal reconstruction with SRPF, at least 6 months follow-up/post-reconstruction. Exclusion criteria- reconstructed without plates, addition and removal of plates multiple times. 106 patients were included.

Results:

There was no difference in duration for those with post-reconstruction infection and those without overall (25.93+/-20.63 vs 28.29+/-21.91, p=0.696), or among the 72 initially infected patients (35.85+/-18.51 vs 38.60+/-16.72, p=0.664), but among the 34 initially clean patients, those who did not develop infection had longer antibiotic courses (8.14+/-9 vs 3.4+/-2.19, p=0.021). The duration of antibiotics was also significantly different when comparing patients based on number of surgical washouts, number of antibiotics given, and number of antibiotic classes used (p <0.001, 0.002, <0.001, respectively). There were no significant differences related to wound culture results or whether or not the patient had a listed penicillin allergy.

Conclusions:

Antibiotic duration in initially infected patients did not have any change in outcome, while a longer course among clean/primarily plated patients is associated with not having post-reconstruction infection. More research is needed, however, since the subset of clean patients from this sample is small.