Safety and Efficacy of an Antibiotic Implant in Cardiac Surgical Subjects at Higher Risk for Sternal Wound Infection

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00600483
Recruitment Status : Completed
First Posted : January 25, 2008
Last Update Posted : March 23, 2012
Duke University
Premier Research Group plc
Information provided by (Responsible Party):

Brief Summary:
The purpose of this study is to determine whether the gentamicin-collagen sponge is safe and effective in preventing sternal wound infections in patients undergoing cardiac surgery who are at a greater risk of developing sternal wound infections.

Condition or disease Intervention/treatment Phase
Cardiac Surgery Sternal Wound Infection Drug: gentamicin-collagen sponge dipped in saline Phase 3

Detailed Description:

Sternal wound infection (SWI) is a significant problem in cardiac surgical subjects,in particular in those with risk factors such as diabetes and obesity. There is a long unmet need for an intervention that can reduce the incidence and severity of SWIs in high-risk subjects.

Gentamicin is an antibiotic that is effective in treating certain kinds of infection. Collagen is a protein that is found in all mammals. The gentamicin-collagen sponge is a thin flat sponge made out of collagen that comes from cow tendons and containing gentamicin. When inserted into a surgical site, the collagen breaks down and the gentamicin is released at the site but very little is absorbed into the blood stream. The high levels of antibiotic at the surgical site may prevent an infection at the surgical site.

Outside of the United States more than 3,500 subjects have received treatment in clinical studies with the gentamicin-collagen sponge, primarily for orthopedic, intraabdominal, and cardiothoracic surgeries or wound infections following surgical procedures or traumatic events.

In this study, all subjects will be given treatment that is normally given to prevent surgical infections. For subjects randomly assigned to the gentamicin-collagen sponge treatment group, 2 sponges will be placed between the sternal halves during surgery. IMMEDIATELY before insertion of the sponge the surgeon should wet the sponge with saline as shown in the training/certification document. This wet sponge SHOULD BE INSERTED INTO THE STERNUM WITHIN APPROXIMATELY 15 SECONDS (AFTER THIS TIME IT MAY BECOME MORE DIFFICULT TO HANDLE). All subjects will be followed for 90 days after surgery to determine whether they develop a sternal wound infection.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1502 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Prevention
Official Title: A Randomized, Controlled, Phase 3 Study of Gentamicin-Collagen Sponge in Cardiac Surgical Subjects at Higher Risk for Sternal Wound Infection
Study Start Date : December 2007
Actual Primary Completion Date : September 2010
Actual Study Completion Date : September 2010

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: 1
Insertion of 2 gentamicin-collagen sponges between the sternal halves before closure of the sternotomy
Drug: gentamicin-collagen sponge dipped in saline
100-cm2 sponge

No Intervention: 2
Standard of care, ie, insertion of no gentamicin-collagen sponge.

Primary Outcome Measures :
  1. Efficacy will be evaluated by a comparison between the 2 study groups of the incidence of surgical wound infections that occur within the period from surgery through postop day 90. [ Time Frame: 90 days post cardiac surgery ]

Secondary Outcome Measures :
  1. Proportion of patients with surgically treated surgical wound infection adjudicated by an independent blinded committee. [ Time Frame: 90 days post cardiac surgery ]
  2. Proportion of patients with deep surgical wound infections based on Centers for Disease Control criteria adjudicated by an independent blinded committee. [ Time Frame: 90 days post cardiac surgery ]
  3. Proportion of patients with superficial surgical wound infections based on Centers for Disease Control criteria adjudicated by an independent blinded committee. [ Time Frame: 90 days post cardiac surgery ]
  4. Efficacy by type of pathogen/bacteriology [ Time Frame: 90 days post cardiac surgery ]
  5. ASEPSIS score [ Time Frame: 90 days post cardiac surgery ]
  6. Rehospitalization for Sternal Wound Infection [ Time Frame: 90 days post cardiac surgery ]
  7. Cost analysis comparison between study groups [ Time Frame: 90 days post cardiac surgery ]
  8. Serum gentamicin levels and changes in serum creatinine level [ Time Frame: 90 days post cardiac surgery ]
  9. Bone and wound healing questionnaire including Emergency Room and surgical office visits secondary to wound complaints [ Time Frame: 90 days post cardiac surgery ]
  10. Pain assessments from surgery through 7 days postoperatively (see section 4.2.) and amount of pain medication administered in the first 3 days postoperatively. [ Time Frame: Through 7 days post cardiac surgery ]
  11. Reporting of serious and nonserious AEs, including reexploration for bleeding and renal failure [ Time Frame: 90 days post cardiac surgery ]
  12. All-cause mortality at 30 days, 60 days, and 90 days postop [ Time Frame: Through 90 days post cardiac surgery ]

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Scheduled to undergo nonemergent CABG and/or valve repair or replacement surgery through a full median sternotomy. This includes the following eligible procedures: isolated CABG surgery, isolated valve surgery, and combined CABG + valve surgery.
  • Be at higher risk for SWI, defined as the presence of diabetes mellitus (treated with either oral agent or insulin) and/or obesity, defined as BMI > 30.
  • Have the capacity to understand and sign an informed consent form.
  • Are male or female and > 18 years of age.
  • If female, be postmenopausal (no menstrual period for a minimum of 1 year), be surgically sterilized and have a negative serum or urine pregnancy test on entry in the study, or agree to use adequate birth control during the study and for 3 months after the administration of study agent. Medically acceptable contraceptives include: (1) approved hormonal contraceptives (such as birth control pills, Depo-Provera, or Lupron Depot), (2) barrier methods (such as a condom or diaphragm) used with a spermicide, or (3) an intrauterine device (IUD).
  • Agree to be available for evaluation from baseline until final evaluation at 90 days postsurgery.

Exclusion Criteria:

  • Known history of hypersensitivity to gentamicin or bovine collagen.
  • Undergoing emergency cardiac surgery (urgent surgery is allowed if informed consent is obtained and the study procedures can be performed).
  • Undergoing a significant concomitant surgical procedure (eg, carotid endarterectomy, aortic root repair or replacement, DHCA, or pulmonary resection).
  • Undergoing a minimally invasive or a thoracic surgical approach.
  • Using a preoperative mechanical assist device or IABP if inserted for shock/low output syndrome (an IABP is allowed if it is inserted for unstable angina).
  • Active and significant systemic infection, eg active endocarditis, or a history of significant recurrent systemic infection.
  • Receiving antibiotic therapy within the 2 weeks before the date of surgery.
  • Preoperative serum creatinine > 3 mg/dL or renal failure requiring dialysis.
  • History of malignancy within the past year (except for squamous or basal cell carcinoma of the skin that has been treated with no evidence of recurrence).
  • History of major organ transplantation, including bone marrow transplantation.
  • Recent history of significant drug or alcohol abuse.
  • Taking systemic immunosuppressive drugs, including steroids (at a dose > 10 mg oral prednisone daily) or a history of a current immunosuppressive condition (eg, symptomatic HIV infection), defined as a CD4 count < 200.
  • Scheduled to receive "stress doses" of glucocorticoids (ie, doses > 2 mg/kg/day of methylprednisolone or equivalent).
  • Pregnant, lactating, or of childbearing potential not practicing a birth control method with a high degree of reliability (defined in section 3.1).
  • Postsurgical life expectancy ≤ 90 days, in the investigator's or sponsor's opinion.
  • Refusal to accept medically indicated blood products.
  • Current participation or participation within 30 days before the start of this study in another experimental drug or device study, or is currently participating in a study during which the administration of investigational drugs within 90 days is anticipated.
  • Has a moderate or severe pectus deformity.

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To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00600483

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Sponsors and Collaborators
Duke University
Premier Research Group plc
Study Director: David Prior Innocoll

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Innocoll Identifier: NCT00600483     History of Changes
Other Study ID Numbers: INN-SWI-001
First Posted: January 25, 2008    Key Record Dates
Last Update Posted: March 23, 2012
Last Verified: March 2012

Keywords provided by Innocoll:

Additional relevant MeSH terms:
Communicable Diseases
Wounds and Injuries
Wound Infection
Anti-Bacterial Agents
Anti-Infective Agents
Protein Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action