Role of Topical Vancomycin in Preventing Sternal Wound Infection Following Coronary Artery Bypass Grafting

<i>Background</i><i>:</i> Sternal wound infection (SWI) remains a serious postoperative complication following coronary artery bypass grafting (CABG), contributing to increased morbidity, prolonged hospitalization and healthcare costs. The use of topical vancomycin powder has emerged as a potential strategy to reduce surgical site infections in cardiac surgery. This study aimed to evaluate the effectiveness of topical vancomycin in preventing SWI among Bangladeshi patients undergoing isolated CABG.<i> </i><i>Methods:</i> This prospective comparative study was conducted at the Department of Cardiac Surgery, United Hospital Limited, Dhaka, Bangladesh, from January 2025 to June 2025. A total of 400 patients undergoing isolated CABG were enrolled and divided into two equal groups: the control group (n = 200) received standard antibiotic prophylaxis, while the other group received vancomycin group (n = 200). Postoperative outcomes, including incidence and microbiology of SWI, ICU stay, hospital stay and 30-day morbidity and mortality, were analyzed.<i> </i><i>Results:</i> The overall incidence of SWI was significantly lower in the vancomycin group (3.0%) compared to the control group (9.0%, p = 0.01). Staphylococcus aureus (both methicillin-sensitive and MRSA) was the predominant pathogen. The vancomycin group showed significantly shorter ICU (3.2 ± 1.6 vs. 3.8 ± 2.1 days, p = 0.01) and hospital stays (9.8 ± 4.3 vs. 12.4 ± 6.5 days, p < 0.001), with lower morbidity rates.<i> </i><i>Conclusion:</i> Topical vancomycin application effectively reduces the incidence of sternal wound infection and shortens postoperative recovery time without increasing adverse outcomes among Bangladeshi CABG patients.