# Application of Continuous Local Antibiotic Perfusion for Postoperative Mediastinitis

## TL;DR

This paper explores the use of continuous local antibiotic perfusion (CLAP) to treat post-surgery mediastinitis, showing promising results in recovery and infection control.

## Contribution

The novel application of CLAP, previously used in orthopedic surgery, to treat mediastinitis after cardiovascular surgery is presented.

## Key findings

- All patients achieved sternal closure without severe adverse events.
- No gentamicin-induced adverse events were observed during treatment.
- The three-year survival rate was 75% with a 100% reinfection-free rate.

## Abstract

Objectives: Postoperative mediastinitis after cardiovascular surgery remains a significant concern because it leads to prolonged hospitalization and increased mortality. Recently, continuous local antibiotic perfusion (CLAP) has been widely used as a new route of antimicrobial administration in orthopedic surgery. We herein report the outcomes of applying CLAP to mediastinitis after cardiovascular surgery.

Methods: Seven patients (mean age, 52±22 years) who underwent CLAP for mediastinitis after cardiovascular surgery at our hospital from May 2020 to December 2024 were enrolled and retrospectively analyzed. Pathogenic bacteria identified included methicillin-resistant Staphylococcus aureus in five patients and Pseudomonas in two patients. The wounds were closed with 18-24 Fr Salem sump tubes placed in the wound after appropriate debridement. A negative pressure continuous therapy device was connected to the main sump tube to maintain a negative pressure of 60 mmHg, with gentamicin at a concentration of 1.2 mg/mL perfused at a rate of 2 mL/h through the subroute.

Results: No hospital mortality occurred. All patients achieved sternal closure without severe adverse events. One patient underwent closure with an omentum flap in the early stages of CLAP implementation. The median length of CLAP was 14 (5-24) days. The mean duration of respiratory support and the duration until oral feeding were 2.5 and 3.3 days after CLAP initiation, respectively. No gentamicin-induced adverse events were observed. The three-year survival rate was 75%, whereas the reinfection-free rate was 100%.

Conclusion: CLAP can be easily introduced to facilitate early extubation, early ambulation, and early resumption of oral intake, which are beneficial for infection control.