Impact of topical vancomycin paste on prevention of deep sternal wound infection in patients undergoing bilateral internal thoracic artery coronary bypass grafting.

INTRODUCTION

Deep sternal wound infection (DSWI) remains a serious complication of coronary artery bypass grafting (CABG), particularly when bilateral internal thoracic arteries (BITA) are used. Concerns regarding DSWI often limit the adoption of multiple arterial grafting.

AIM: To evaluate the effect of topical vancomycin paste on the incidence of DSWI in patients undergoing primary isolated CABG with BITA.

MATERIAL AND

METHODS

This multicenter, retrospective study analyzed 1,694 patients who underwent BITA grafting between 2006 and 2024. Patients were stratified based on whether topical vancomycin paste was applied to the sternal edges (n = 455) or not (n = 1,239). Propensity score matching was used to account for baseline differences, generating 368 matched pairs. Odds ratios (ORs) were estimated using multivariable and conditional logistic regression.

RESULTS

Multivariable logistic regression demonstrated that the use of topical vancomycin paste was independently associated with a 63% reduction in DSWI (OR = 0.37; 95% CI: 0.14-0.97; p = 0.045). Other independent predictors of increased DSWI risk included age ≥ 60 years, obesity, chronic lung disease, insulin therapy, female sex, and heart failure symptoms. After propensity score matching, 368 well-balanced pairs were obtained. In this matched cohort, topical vancomycin paste was associated with a substantial reduction in DSWI (OR = 0.17; 95% CI: 0.05-0.60; p = 0.001).

CONCLUSIONS

Topical application of vancomycin paste significantly reduces the risk of DSWI in patients undergoing CABG with BITA. This simple and effective prophylactic measure may help enable safer and broader adoption of multiple arterial grafting strategies.