Coronary artery bypass surgery management of perioperative infection

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[1]

Mediastinitis/Perioperative Infection (DO NOT EDIT)[1]

Class I
"1. Preoperative antibiotics should be administered to all patients to reduce the risk of postoperative infection.[2][3][4][5][6][7] (Level of Evidence: A)"
"2. A first- or second-generation cephalosporin is recommended for prophylaxis in patients without methicillin-resistant Staphylococcus aureus colonization.[6][8][9][10][11][12][13][14][15] (Level of Evidence: A)"
"3. Vancomycin alone or in combination with other antibiotics to achieve broader coverage is recommended for prophylaxis in patients with proven or suspected methicillin-resistant S. aureus colonization.[10][16][17][18] (Level of Evidence: B)"
"4. A deep sternal wound infection should be treated with aggressive surgical debridement in the absence of complicating circumstances. Primary or secondary closure with muscle or omental flap is recommended.[19][20][21] Vacuum therapy in conjunction with early and aggressive debridement is an effective adjunctive therapy.[22][23][24][25][26][27][28][29][30][31] (Level of Evidence: B)"
"5. Use of a continuous intravenous insulin protocol to achieve and maintain an early postoperative blood glucose concentration less than or equal to 180 mg/dL while avoiding hypoglycemia is indicated to reduce the risk of deep sternal wound infection.[32][33][34][35][36][37] (Level of Evidence: B)"
Class IIa
"1. When blood transfusions are needed, leukocyte-filtered blood can be useful to reduce the rate of overall perioperative infection and in-hospital death.[38][39][40][41] (Level of Evidence: B)"
"2. The use of intranasal mupirocin is reasonable in nasal carriers of Staphylococcus aureus.[42][43] (Level of Evidence: A)"
"3. The routine use of intranasal mupirocin is reasonable in patients who are not carriers of S. aureus, unless an allergy exists. (Level of Evidence: C)"
Class IIb
"1. The use of bilateral internal mammary arteries in patients with diabetes mellitus is associated with an increased risk of deep sternal wound infection, but it may be reasonable when the overall benefit to the patient outweighs this increased risk. (Level of Evidence: C)"

Sources

  • 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[1]

References

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  21. Wong CH, Senewiratne S, Garlick B, Mullany D (2006). "Two-stage management of sternal wound infection using bilateral pectoralis major advancement flap". European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 30 (1): 148–52. doi:10.1016/j.ejcts.2006.03.049. PMID 16725333. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
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