Application of Continuous Local Antibiotic Perfusion for Postoperative Mediastinitis

Sep 28, 2026

Uploaded by Kurz

Postoperative mediastinitis after cardiovascular surgery prolongs hospitalization and increases mortality, creating an ongoing clinical need for effective antimicrobial strategies. Seven patients treated with continuous local antibiotic perfusion (CLAP) at a single center from May 2020 to December 2024 were retrospectively reviewed. Pathogens included methicillin-resistant Staphylococcus aureus and Pseudomonas. CLAP combined debridement, sternal management, and gentamicin perfusion via sump-tube drainage under negative pressure.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Objectives

Methods

Results

Conclusion

Introduction

Materials And Methods

Patient selection and study design

Continuous local antibiotic perfusion

Review began 10/25/2025 Review ended 11/23/2025 Published 12/03/2025 © Copyright 2025 Yokawa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98405 Open Access Original Article Application of Continuous Local Antibiotic Perfusion for Postoperative Mediastinitis Koki Yokawa 1, Taku Nakagawa 1, Makoto Kusakizako 1, Tomonori Higuma 1, Yosuke Tanaka 1 , Kazunori Yoshida 1, Yoshihiro Oshima 1, Hidefumi Obo 1, Hidetaka Wakiyama 1 1. Department of Cardiovascular Surgery, Kakogawa Central City Hospital, Kakogawa, JPN Corresponding author: Hidetaka Wakiyama, [h-wakiyama@kakohp.jp](h-wakiyama@kakohp.jp) 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 mainsump 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. Categories: Cardiac/Thoracic/Vascular Surgery, Infectious Disease Keywords: adult cardiac surgery, continuous local antibiotic perfusion, mediastinitis, postoperative complication, surgical site infection Introduction Mediastinitis is a critical complication after cardiac and aortic surgeries via median sternotomy that can occasionally follow a highly severe clinical course [1] . Previous studies have demonstrated the effectiveness of continuous suction irrigation methods and the necessity of omental filling for treating mediastinitis [2,3] . However, continuous suction irrigation in an open-chest state or frequent open-chest washouts can significantly weaken the patient’s physical condition, leading to malnutrition, a decline in activities of daily living (ADLs), and, in some cases, death [4] . Treating infections requires not only systemic antibiotic administration but also a multidisciplinary approach that includes preventing nutritional decline and deterioration of ADLs. Moreover, although intravenous antibiotic administration has been the standard treatment for perioperative infections, whether such an approach is truly optimal and sufficient remains unclear. Recently, researchers in orthopedics have developed continuous local antibiotic perfusion (CLAP) as a treatment for contaminated wounds, such as open fractures, and ha

FAQs

What is continuous local antibiotic perfusion (CLAP) in this study?

CLAP delivers antibiotics locally through a sump-tube drainage system connected to negative pressure therapy, allowing gentamicin perfusion into the wound route.

How many patients were included and what time period were they treated in?

Seven patients were enrolled, treated from May 2020 through December 2024, with mediastinitis managed using CLAP.

What were the key outcomes reported after CLAP?

No hospital mortality occurred, all patients achieved sternal closure without severe adverse events, and gentamicin-related adverse events were not observed; three-year survival was 75% with a reinfection-free rate of 100%.

Sep 28, 2026

Uploaded by Kurz