Article 2025 · 0 citations

Immunonutritional Markers and the Protective Role of Sternal Irrigation and Antibiotic-Impregnated Membranes in Sternal Wound Infection: A Retrospective Cohort Study

Sonmez, Ebubekir, Jalalzai, Izatullah, Arslan, Umit, Yildiz, Alperen, Celik, Furkan, Cetin, Merve

Abstract

Background: Sternal wound infections (SWIs) remain a significant complication following cardiac surgery. Inflammatory and nutritional status are increasingly recognized as key contributors to their development. This study aimed to investigate the predictive utility of immunonutritional biomarkers and to evaluate the protective effect of combining sternal irrigation with an antibiotic-impregnated membrane. Methods: This retrospective cohort study included 480 patients undergoing off-pump coronary artery bypass grafting. Patients were categorized based on sternal management strategy (standard closure or local prophylaxis using gentamicin-enriched irrigation combined with an antibiotic-impregnated fascia lata membrane) and according to the severity of SWIs, classified as superficial or deep. Inflammatory and nutritional markers-including C-reactive protein (CRP), neutrophils, lymphocytes, albumin, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), and prognostic nutritional index (PNI)-were assessed at three time points: preoperatively, on postoperative day 3, and after week 1. Results: SWIs were observed in 93 patients, including 75 superficial and 18 deep infections. The combined prophylactic approach was associated with a nearly 1.8-fold reduction in deep SWIs (OR: 0.55; 95% CI: 0.15-0.87) and a modest reduction in superficial infections (OR: 0.89; 95% CI: 0.5-1.3; p = 0.061). Threshold values of 3.75 for preoperative NLR, 9.8 for Delta NLR, and 16.7 for Delta CAR demonstrated strong predictive capacity for identifying patients at increased risk of developing deep SWIs. Patients receiving local prophylaxis exhibited significantly lower CRP, NLR, and CAR values and higher PNI levels at all time points. Conclusions: The combination of sternal irrigation and local antibiotic prophylaxis appears to confer protection against SWIs, potentially by mitigating postoperative inflammation. Immunonutritional biomarkers offer a promising means for early risk stratification. To confirm their clinical utility and broader applicability, these results should be validated in prospective, multicenter studies encompassing a wider range of cardiac surgical procedures.

Keywords

sternal wound infection sternotomy local antibiotic prophylaxis collagen membrane CRP neutrophil-to-lymphocyte ratio CRP-to-albumin ratio prognostic nutritional index inflammation biomarkers GENTAMICIN-COLLAGEN SPONGE SURGICAL SITE INFECTION TO-LYMPHOCYTE RATIO OPEN-HEART-SURGERY CARDIAC-SURGERY LOCAL GENTAMICIN VANCOMYCIN PASTE PREVENTION RISK MANAGEMENT

WoS Categories

Biology Microbiology

Sustainable Development Goals

Good Health and Well-being

Citation

Journal: LIFE-BASEL
Year: 2025
Volume: 15
Issue: 8
eISSN: 2075-1729
DOI: 10.3390/life15081163
WoS UID: WOS:001558640700001

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