Abstract 4344059: Local Application of Vancomycin Powder Reduces Postoperative Complications Following Median Sternotomy in Cardiac Surgery: A Randomized Controlled Trial

Introduction: Sternal wound infections (SWIs) are serious complications following median sternotomy in cardiac surgeries such as coronary artery bypass grafting (CABG), valve replacements, and atrial septal defect (ASD) repairs. Topical vancomycin powder (VP) has been proposed as a preventive measure, but its efficacy remains uncertain. Research Question: Does intraoperative vancomycin powder reduce SWIs and improve early postoperative outcomes in cardiac surgery via median sternotomy? Methods: In this single-blinded, single-center randomized controlled trial in Karachi, Pakistan (ClinicalTrials.gov ID: NCT06329016), 24 adults undergoing CABG, valve replacement, or ASD repair via median sternotomy were randomized to receive either 1g of vancomycin powder (n=12) or no powder (control, n=12) prior to sternal closure. SWIs were assessed clinically at 48 hours, day 7, and 1 month based on redness, tenderness, swelling, and discharge. Additional outcomes included ICU/ward stay and wound healing. Results: Of 24 randomized patients (12 control, 12 VP), the control group had 6 females; VP group had 4. Surgical types and operative durations were comparable; 10 VP patients had procedures <180 minutes. No open-chest cases occurred. SWIs were seen in 33.3% (4/12) of control vs 8.3% (1/12) of VP group (p=0.140). One control patient required re-exploration; none in VP group did. ICU stay <3 days occurred in 58.3% (control) vs 83.3% (VP); ICU stay >3 days in 41.7% vs 16.7%, respectively. Ward stay >10 days was significantly higher in the control group (75.0%) vs VP (8.3%) (p=0.001). Conversely, 25.0% of control and 91.7% of VP patients had ward stays <10 days. Re-admissions occurred in 3/7 infected control patients (42.9%) and 1/12 VP patients (8.3%). Wound discharge occurred in 3/4 control and 1/1 VP patient. Serous discharge occurred in 1 control patient; purulent in 2 control and 1 VP patient. No vancomycin-related adverse events were observed. Conclusion: Topical vancomycin powder may enhance wound healing and reduce hospital stay in cardiac surgery patients via median sternotomy. Though the reduction in SWI was not statistically significant, results support a favorable safety and efficacy profile, warranting further study in larger trials.