A single-center, prospective, single-blind trial randomized 360 adults undergoing elective full sternotomy cardiac surgery to topical vancomycin paste or normal saline. Grade 2 or higher sternal wound infection within 90 days occurred in 1 of 180 vancomycin recipients versus 7 of 180 controls (0.6% versus 3.9%; p = .031). The subdistribution hazard ratio was 0.14 (p = .065). Deep infection rates were 0.6% versus 2.8% (p = .099). Three vancomycin-resistant Enterococcus cases from various sources occurred among vancomycin recipients with chronic kidney disease stage 3 or higher or undergoing hemodialysis.
Topical vancomycin showed fewer grade 2 or higher sternal wound infections in this trial, but the hazard analysis and deep infection comparison were inconclusive; these findings do not establish overall safety.
Study limitation: This single-center trial recorded few infection events, limiting precision; resistant-organism findings and systemic exposure in hemodialysis warrant caution.
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