Management of mediastinitis and preventions of perioperative nosocomial infection after cardiovascular surgery
Ishibashi, K.; Yamamoto, F.
Kyobu Geka. Japanese Journal of Thoracic Surgery 61(8 Suppl): 644-648
2008
ISSN/ISBN: 0021-5252 PMID: 20715403 Document Number: 618152
This article reviews risk factors and treatment of perioperative nosocomial infections. The primary prophylactic antibiotic is recommended to be a cefazolin or penicillin with sulbactam, because the most frequent organism cultured in cardiac surgical site infection (SSI) is Staphyloccocus. Antibiotic prophylaxis of 48 hours' duration after cardiovascular surgery is clinically effective in minimizing infectious complication. In patients considered at high risk for a staphylococcal infection, vancomycin may be recommended. In the treatment of postoperative infections, Gram-stain-based antibiotic selection is necessary and the initial empirical therapy to ensure adequate coverage of potentially infective organisms should be accompanied by de-escalation until microbiological data become available. Mediastinitis, which is one of the important infectious complications after cardiovascular surgery, requires surgical drainage and debridement, as well as antimicrobial therapy. Vacuum-assisted closure (VAC) is an effective therapy compared with the conventional technique of open packing. Continuous clinician's efforts and prolonged infection control programs are very important for prevention of perioperative nosocomial infection after cardiac surgery.