Sandbox ID Cardiovascular: Difference between revisions

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::::* Preferred regimen: [[Linezolid]] IV 600 mg q12h {{or}} [[Daptomycin]] 6 mg/kg per day IV.
::::* Preferred regimen: [[Linezolid]] IV 600 mg q12h {{or}} [[Daptomycin]] 6 mg/kg per day IV.
::::* Alternative regimen: [[Quinupristin]]/[[Dalfopristin]] 7.5 mg/kg IV q8h.
::::* Alternative regimen: [[Quinupristin]]/[[Dalfopristin]] 7.5 mg/kg IV q8h.
::* '''Gram-negative bacilli'''
::* 1.4. '''Gram-negative bacilli'''
:::* [[Escherichia coli]] and [[Klebsiella]] species
:::* 1.4.1. '''Escherichia coli and Klebsiella species'''
::::* ESBL negative
::::* 1.4.1.1. '''ESBL negative'''
:::::* Preferred regimen: [[Ceftriaxone]]  1–2 g per day IV.
:::::* Preferred regimen: [[Ceftriaxone]]  1–2 g per day IV.
:::::* Alternative regimen:  [[Ciprofloxacin]] IV {{or}} [[Aztreonam]] IV.
:::::* Alternative regimen:  [[Ciprofloxacin]] IV {{or}} [[Aztreonam]] IV.
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::::::* Neonates: 7–40 mg/kg/day divided every 12 h.  
::::::* Neonates: 7–40 mg/kg/day divided every 12 h.  
::::::* Infants and children: 20–30 mg/kg/day divided every 12 h.
::::::* Infants and children: 20–30 mg/kg/day divided every 12 h.
::::* ESBL positive
::::* 1.4.1.2. '''ESBL positive'''
:::::* Preferred regimen: [[Ertapenem]] 1 g per day IV {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Doripenem]] 500 mg IV q8h.
:::::* Preferred regimen: [[Ertapenem]] 1 g per day IV {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Doripenem]] 500 mg IV q8h.
:::::* Alternative regimen:  [[Ciprofloxacin]] IV {{or}} [[Aztreonam]] IV.
:::::* Alternative regimen:  [[Ciprofloxacin]] IV {{or}} [[Aztreonam]] IV.
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:::::::* Postnatal age >7 days and >2000 g, 20 mg/kg every 8 h.
:::::::* Postnatal age >7 days and >2000 g, 20 mg/kg every 8 h.
::::::* Infants ≥3 months of age and children: 20 mg/kg every 8 h.
::::::* Infants ≥3 months of age and children: 20 mg/kg every 8 h.
:::* '''Enterobacter species and Serratia marcescens'''
:::* 1.4.2. '''Enterobacter species and Serratia marcescens'''
::::* Preferred regimen: [[Ertapenem]] 1 g per day IV {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h.
::::* Preferred regimen: [[Ertapenem]] 1 g per day IV {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h.
::::* Alternative regimen:  [[Cefepime]] IV {{or}} [[Ciprofloxacin]] IV.
::::* Alternative regimen:  [[Cefepime]] IV {{or}} [[Ciprofloxacin]] IV.
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::::::* Neonates 14 days of age: 30 mg/kg every 12 h.
::::::* Neonates 14 days of age: 30 mg/kg every 12 h.
::::::* Infants >14 days of age and Children 40 kg in weight: 50 mg/kg every 12 h.
::::::* Infants >14 days of age and Children 40 kg in weight: 50 mg/kg every 12 h.
:::* '''Acinetobacter'''
:::* 1.4.3. '''Acinetobacter'''
::::* Preferred regimen: [[Ampicillin]]/[[Sulbactam]] 3 g IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h.
::::* Preferred regimen: [[Ampicillin]]/[[Sulbactam]] 3 g IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h.
:::* '''Stenotrophomonas maltophilia'''
:::* 1.4.4. '''Stenotrophomonas maltophilia'''
::::* Preferred regimen: [[Trimethoprim]]-[[sulfamethoxazole]] 3–5 mg/kg IV q8h.
::::* Preferred regimen: [[Trimethoprim]]-[[sulfamethoxazole]] 3–5 mg/kg IV q8h.
::::* Alternative regimen: [[Ticarcillin]] IV {{and}} [[Clavulanate]] IV.
::::* Alternative regimen: [[Ticarcillin]] IV {{and}} [[Clavulanate]] IV.
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:::::::* Postnatal age >7 days and >2000 g, 300 mg/kg/day in divided doses every 6–8 h.  
:::::::* Postnatal age >7 days and >2000 g, 300 mg/kg/day in divided doses every 6–8 h.  
::::::* Infants and children: 200–300 mg/kg/day in divided doses every 4–6 2.
::::::* Infants and children: 200–300 mg/kg/day in divided doses every 4–6 2.
:::* '''Pseudomonas aeruginosa'''
:::* 1.4.5. '''Pseudomonas aeruginosa'''
::::* Preferred regimen: [[Cefepime]], 2 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Piperacillin]] IV  and [[Tazobactum]] 4.5 g IV q6h {{or}} [[Amikacin]] 15 mg/kg once a day IV {{or}} [[Tobramycin]] 5–7 mg/kg once a day IV.
::::* Preferred regimen: [[Cefepime]], 2 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Piperacillin]] IV  and [[Tazobactum]] 4.5 g IV q6h {{or}} [[Amikacin]] 15 mg/kg once a day IV {{or}} [[Tobramycin]] 5–7 mg/kg once a day IV.
::::* Pediatric dose:  
::::* Pediatric dose:  
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:::::::* Postnatal age >7 days and >2000 g, 10 mg/kg every 8 h.  
:::::::* Postnatal age >7 days and >2000 g, 10 mg/kg every 8 h.  
:::::::* Infants and children: 15–22.5 mg/kg/day divided every 8 h.
:::::::* Infants and children: 15–22.5 mg/kg/day divided every 8 h.
:::* '''Burkholderia cepacia'''
:::* 1.4.6. '''Burkholderia cepacia'''
::::* Preferred regimen: [[Trimethoprim]]-[[sulfamethoxazole]] 3–5 mg/kg IV q8h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1g IV q8h.
::::* Preferred regimen: [[Trimethoprim]]-[[sulfamethoxazole]] 3–5 mg/kg IV q8h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1g IV q8h.
* '''Fungi'''
:* 1.2. '''Fungi'''
:* '''Candida albicans or other Candida species'''
::* 1.2.1. '''Candida albicans or other Candida species'''
::* Preferred regimen: [[Caspofungin]] 70-mg loading dose, then 50 mg per day {{or}} [[Micafungin]], 100 mg per day {{or}}  [[Anidulafungin]], 200 mg loading dose followed by 100 mg per day {{or}} [[fluconazole]], 400–600 mg per day.
:::* Preferred regimen: [[Caspofungin]] 70-mg loading dose, then 50 mg per day {{or}} [[Micafungin]], 100 mg per day {{or}}  [[Anidulafungin]], 200 mg loading dose followed by 100 mg per day {{or}} [[fluconazole]], 400–600 mg per day.
::* Alternative regimen: [[Lipid]]  [[amphotericin B]] preparations.
:::* Alternative regimen: [[Lipid]]  [[amphotericin B]] preparations.
:::* Pediatric dose:  
::::* Pediatric dose:  
::::* [[Caspofungin]]
:::::* [[Caspofungin]]
:::::* Intravenous dosing: infants and children aged 3 months–17 years: loading dose of 70 mg/m2/day on day 1 followed by 50 mg/m2/day thereafter.
::::::* Intravenous dosing: infants and children aged 3 months–17 years: loading dose of 70 mg/m2/day on day 1 followed by 50 mg/m2/day thereafter.
::::* [[Micafungin]]
:::::* [[Micafungin]]
:::::* Children 12 years of age: 1–4 mg/kg/day
::::::* Children 12 years of age: 1–4 mg/kg/day
::::* [[Anidulafungin]]
:::::* [[Anidulafungin]]
:::::* Children 2– 17 years of agea: 1.5 mg/kg/day
::::::* Children 2– 17 years of agea: 1.5 mg/kg/day
* '''Uncommon pathogens'''
:* 1.3. '''Uncommon pathogens'''
:* '''Corynebacterium jeikeium''' (group JK)
::* 1.3.1. '''Corynebacterium jeikeium''' (group JK)
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
:::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
::* Alternative regimen: [[Linezolid]] IV.
:::* Alternative regimen: [[Linezolid]] IV.
:* '''Chryseobacterium (Flavobacterium)'''  
::* 1.3.2. '''Chryseobacterium (Flavobacterium)'''  
::* Preferred regimen: [[Levofloxacin]] 750 mg IV qd.
:::* Preferred regimen: [[Levofloxacin]] 750 mg IV qd.
::* Alternative regimen: [[Trimethoprim]]-[[sulfamethoxazole]] IV {{or}} [[Imipenem]] IV {{or}} [[Meropenem]] IV.
:::* Alternative regimen: [[Trimethoprim]]-[[sulfamethoxazole]] IV {{or}} [[Imipenem]] IV {{or}} [[Meropenem]] IV.
:* '''Ochrobacterium anthropi'''
::* 1.3.3. '''Ochrobacterium anthropi'''
::* Preferred regimen: [[Trimethoprim]]-[[sulfamethoxazole]] 3–5 mg/kg IV q8h {{or}} [[ciprofloxacin]] 400 mg IV q12h.
:::* Preferred regimen: [[Trimethoprim]]-[[sulfamethoxazole]] 3–5 mg/kg IV q8h {{or}} [[ciprofloxacin]] 400 mg IV q12h.
:* '''Malassezia furfur'''
::* 1.3.4. '''Malassezia furfur'''
::* Preferred regimen: [[Amphotericin B]] IV.
:::* Preferred regimen: [[Amphotericin B]] IV.
::* Alternative regimen:  [[Voriconazole]] IV.
:::* Alternative regimen:  [[Voriconazole]] IV.
:::* Pediatric dose:  
::::* Pediatric dose:  
::::* [[Voriconazole]]  
:::::* [[Voriconazole]]  
:::::* Children 12 years of age: 6 mg/kg every 12 h for 2 doses on day 1 (loading dose) followed by 4 mg/kg every 12 h (note: doses as high as 8 mg/kg every 12 h have been reported.
::::::* Children 12 years of age: 6 mg/kg every 12 h for 2 doses on day 1 (loading dose) followed by 4 mg/kg every 12 h (note: doses as high as 8 mg/kg every 12 h have been reported.
Note<ref name=CDC- The Center of disease control and prevention>{{cite web | title = CDC Guidelines for prevention of catheter related infections| url =http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf }}</ref>
* Note (1)<ref name=CDC- The Center of disease control and prevention>{{cite web | title = CDC Guidelines for prevention of catheter related infections| url =http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf }}</ref>: Scheduled replacement of [[intravascular catheters]] has been proposed as a method to prevent [[phlebitis]] and catheter related [[infections]]. No specific recommendation can be made regarding routine replacement of catheters that need to be in place for >7 days
:* Scheduled replacement of [[intravascular catheters]] has been proposed as a method to prevent [[phlebitis]] and catheter related [[infections]]. No specific recommendation can be made regarding routine replacement of catheters that need to be in place for >7 days
:* Note (2): [[Peripheral Venous Catheters]]: Short peripheral [[catheter]] sites commonly are rotated at 72–96-hour intervals. There is no need to replace peripheral catheters more frequently than every 72-96 hours to reduce risk of [[infection]] and [[phlebitis]] in adults. Replace peripheral catheters in children only when clinically indicated. Replace midline catheters only when there is a specific indication.
:* [[Peripheral Venous Catheters]]: Short peripheral [[catheter]] sites commonly are rotated at 72–96-hour intervals. There is no need to replace peripheral catheters more frequently than every 72-96 hours to reduce risk of [[infection]] and [[phlebitis]] in adults. Replace peripheral catheters in children only when clinically indicated. Replace midline catheters only when there is a specific indication.
:* Note (3): Midline Catheters: Midline [[catheters]] were in place a median of 7 days, but for as long as 49 days.
:* Midline Catheters: Midline [[catheters]] were in place a median of 7 days, but for as long as 49 days.
:* Note (4): Hemodialysis Catheters: [[Hemodialysis]] catheters should be avoided in favor of [[arteriovenous fistulas]] and [[grafts]]. If temporary access is needed for [[dialysis]], a cuffed [[catheter]] is preferable to a noncuffed [[catheter]], even in the [[ICU]] setting, if the [[catheter]] is expected to stay in place for >3 weeks.
:* Hemodialysis Catheters: [[Hemodialysis]] catheters should be avoided in favor of [[arteriovenous fistulas]] and [[grafts]]. If temporary access is needed for [[dialysis]], a cuffed [[catheter]] is preferable to a noncuffed [[catheter]], even in the [[ICU]] setting, if the [[catheter]] is expected to stay in place for >3 weeks.
:* Note (5): [[Pulmonary Artery Catheters]]: [[Pulmonary Artery Catheters]] typically remain in place an average of 3 days.
:* [[Pulmonary Artery Catheters]]: [[Pulmonary Artery Catheters]] typically remain in place an average of 3 days.
:* Note (6): An umbilical catheter may be replaced if it is malfunctioning, and there is no other indication for catheter removal, and the total duration of catheterization has not exceeded 5 days for an [[umbilical artery]] catheter or 14 days for an [[umbilical vein]] catheter.
:* An umbilical catheter may be replaced if it is malfunctioning, and there is no other indication for catheter removal, and the total duration of catheterization has not exceeded 5 days for an [[umbilical artery]] catheter or 14 days for an [[umbilical vein]] catheter.
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Revision as of 16:38, 4 August 2015


Intravascular catheter-related infections

  • 1. Pathogen based treatment[1]
  • 1.1. Gram positive bacilli
  • 1.1.1 Staphylococcus aureus
  • 1.1.1.1. Methicillin susceptible
  • Neonates
  • 0–4 weeks of age and 1200 g- 50 mg/kg/day in divided doses every 12 h
  • <=7 days and 1200–2000 g- 50 mg/kg/day in divided doses every 12 h
  • >7 days of age and <2000g- 75 mg/kg/day in divided doses every 8 h
  • >7 days of age and >1200 g - 100 mg/kg/day in divided doses every 6 h
  • Neonates
  • 0–4 weeks of age and 1200 g- 50 mg/kg/day in divided doses every 12 h
  • Postnatal age < 7 days and 1200–2000 g- 50–100 mg/kg/day in divided doses every 12 h
  • Postnatal age < 7 days and >2000 g, 75–150 mg/kg/day in divided doses every 8 h
  • Postnatal age >=7 days and 1200–2000 g- 75–150 mg/kg/day in divided doses every 8 h
  • Postnatal age >=7 days and >2000 g, 100–200 mg/kg/day in divided doses every 6 h
  • Infants and children Nafcillin 100–200 mg/kg/day in divided doses every 4–6 h
  • Neonates
  • Postnatal age <=7 days: 40 mg/kg/day divided every 12 h
  • Postnatal age >7 days and 2000 g: 40 mg/kg/day divided every 12 h
  • Postnatal age >7 days and 12000 g: 60 mg/kg/day divided every 8 h
  • Infants and children: 50 mg/kg/day divided every 8 h
  • Neonates
  • Postnatal age <=7 days and <1200 g, 15 mg/kg/day given every 24 h
  • Postnatal age <=7 days and 1200–2000 g, 10–15 mg/kg given every 12–18 h
  • Postnatal age <=7 days and >2000 g, 10–15 mg/kg given every 8–12 h
  • Postnatal age >7 days and <1200 g, 15 mg/kg/day given every 24 h
  • Postnatal age >7 days and 1200–2000 g, 10–15 mg/kg given every 8–12 h
  • Postnatal age >7 days and >2000 g, 15–20 mg/kg given every 8 h
  • Infants and children: 40 mg/kg/day in divided doses every 6–8 h
  • 1.1.1.2. Methicillin resistant Staphylococcus aureus
  • Neonates
  • 0–4 weeks of age and birthweight <1200 g: 10 mg/kg every 8–12 h (note: use every 12 h in patients <34 weeks gestation and <1 week of age)
  • <7 days of age and birthweight >1200 g, 10 mg/kg every 8–12 h (note: use every 12 h in patients <34 weeks gestation and <1 week of age)
  • 7 days and birthweight >1200 g, 10 mg/kg every 8 h
  • Infants and children <12 years of age: 10 mg/kg every 8 h Children 12 years of age and adolescents: 10 mg/kg every 12 h
  • Neonates
  • Premature neonates and <1000 g, 3.5 mg/kg every 24 h; 0–4 weeks and <1200 g, 2.5 mg/kg every 18–24 h
  • Postnatal age 7 days: 2.5 mg/kg every 12 h
  • Postnatal age 17 days and 1200–2000 g, 2.5 mg/kg every 8–12 h
  • Postnatal age 17 days and 12000 g, 2.5 mg/kg every 8 h
  • Once daily dosing for premature neonates with normal renal function, 3.5–4 mg/kg every 24 h
  • Once daily dosing for term neonates with normal renal function, 3.5–5 mg/kg every 24 h
  • Infants and children <5 years of age: 2.5 mg/kg every 8 h; once daily dosing in patients with normal renal function, 5–7.5 mg/kg every 24 h
  • Children >5 years of age: 2–2.5 mg/kg every 8 h; once daily dosing in patients with normal renal function, 5–7.5 mg/kg every 24 h
  • Infants 12 months of age and children: mild-to-moderate infections, 6–12 mg TMP/kg/day in divided doses every 12 h; serious infection, 15–20 mg TMP/kg/day in divided doses every 6–8 h
  • 1.2. Coagulase-negative staphylococci
  • Methicillin resistant
  • 1.3. Enterococcus faecalis/Enterococcus faecium
  • Neonates
  • Postnatal age <=7 days and <=2000 g: 50 mg/kg/day divided every 12 h.
  • Postnatal age <=7 days and >2000 g, 75 mg/kg/day divided every 8 h.
  • Postnatal age >7 days and <1200 g, 50 mg/kg/day divided every 12 h.
  • Postnatal age >7 days and 1200–2000 g, 75 mg/kg/day divided every 8 h.
  • Postnatal age >7 days and >2000 g, 100 mg/kg/day divided every 6 h.
  • Infants and children: 100–200 mg/kg/day divided every 6 h 1
  • 1.4. Gram-negative bacilli
  • 1.4.1. Escherichia coli and Klebsiella species
  • 1.4.1.1. ESBL negative
  • Pediatric dose:
  • Neonates
  • Postnatal age <=7 days, 50 mg/kg/day given every 24 h.
  • Postnatal age >7 days and <=2000 g, 50 mg/kg/day given every 24 h.
  • Postnatal age >7 days and >2000 g, 50–75 mg/kg/day given every 24 h.
  • Infants and children: 50–75 mg/kg/day divided every 12–24 h.
  • Neonates: 7–40 mg/kg/day divided every 12 h.
  • Infants and children: 20–30 mg/kg/day divided every 12 h.
  • 1.4.1.2. ESBL positive
  • Pediatric dose:
  • Neonates
  • Postnatal age 0–7 days, 20 mg/kg every 12 h.
  • Postnatal age >7 days and 1200–2000 g, 20 mg/kg every 12 h.
  • Postnatal age >7 days and >2000 g, 20 mg/kg every 8 h.
  • Infants ≥3 months of age and children: 20 mg/kg every 8 h.
  • 1.4.2. Enterobacter species and Serratia marcescens
  • Neonates 14 days of age: 30 mg/kg every 12 h.
  • Infants >14 days of age and Children 40 kg in weight: 50 mg/kg every 12 h.
  • 1.4.3. Acinetobacter
  • 1.4.4. Stenotrophomonas maltophilia
  • Neonates
  • Postnatal age <=7 days and 2000 g, 150 mg/kg/day in divided doses every 12 h.
  • Postnatal age <=7 days and >2000 g, 225 mg/kg/day in divided doses every 8 h.
  • Postnatal age >7 days and <1200 g, 150 mg/kg/day in divided doses every 12 h.
  • Postnatal age >7 days and 1200–2000 g, 225 mg/kg/day in divided doses every 8h.
  • Postnatal age >7 days and >2000 g, 300 mg/kg/day in divided doses every 6–8 h.
  • Infants and children: 200–300 mg/kg/day in divided doses every 4–6 2.
  • 1.4.5. Pseudomonas aeruginosa
  • Neonates
  • 0–4 weeks of age and <1200 g, 7.5 mg/kg every 18–24 h.
  • Postnatal age <=7 days and 1200–2000 g, 7.5 mg/ kg every 12 h.
  • Postnatal age <=7 days and >2000 g, 7.5–10 mg/kg every 12 h.
  • Postnatal age >7 days and 1200–2000 g, 7.5–10 mg/kg every 8–12 h.
  • Postnatal age >7 days and >2000 g, 10 mg/kg every 8 h.
  • Infants and children: 15–22.5 mg/kg/day divided every 8 h.
  • 1.4.6. Burkholderia cepacia
  • 1.2. Fungi
  • 1.2.1. Candida albicans or other Candida species
  • Pediatric dose:
  • Intravenous dosing: infants and children aged 3 months–17 years: loading dose of 70 mg/m2/day on day 1 followed by 50 mg/m2/day thereafter.
  • Children 12 years of age: 1–4 mg/kg/day
  • Children 2– 17 years of agea: 1.5 mg/kg/day
  • 1.3. Uncommon pathogens
  • 1.3.1. Corynebacterium jeikeium (group JK)
  • 1.3.2. Chryseobacterium (Flavobacterium)
  • 1.3.3. Ochrobacterium anthropi
  • 1.3.4. Malassezia furfur
  • Pediatric dose:
  • Children 12 years of age: 6 mg/kg every 12 h for 2 doses on day 1 (loading dose) followed by 4 mg/kg every 12 h (note: doses as high as 8 mg/kg every 12 h have been reported.
  • Note (1): Scheduled replacement of intravascular catheters has been proposed as a method to prevent phlebitis and catheter related infections. No specific recommendation can be made regarding routine replacement of catheters that need to be in place for >7 days
  • Note (2): Peripheral Venous Catheters: Short peripheral catheter sites commonly are rotated at 72–96-hour intervals. There is no need to replace peripheral catheters more frequently than every 72-96 hours to reduce risk of infection and phlebitis in adults. Replace peripheral catheters in children only when clinically indicated. Replace midline catheters only when there is a specific indication.
  • Note (3): Midline Catheters: Midline catheters were in place a median of 7 days, but for as long as 49 days.
  • Note (4): Hemodialysis Catheters: Hemodialysis catheters should be avoided in favor of arteriovenous fistulas and grafts. If temporary access is needed for dialysis, a cuffed catheter is preferable to a noncuffed catheter, even in the ICU setting, if the catheter is expected to stay in place for >3 weeks.
  • Note (5): Pulmonary Artery Catheters: Pulmonary Artery Catheters typically remain in place an average of 3 days.
  • Note (6): An umbilical catheter may be replaced if it is malfunctioning, and there is no other indication for catheter removal, and the total duration of catheterization has not exceeded 5 days for an umbilical artery catheter or 14 days for an umbilical vein catheter.

Mediastinitis, acute

  • Treatment secondary to cardiac infection and surgery[2].
  • Prophylaxis
  • Methicillin susceptible staphylococcus aureus infection
  • Methicillin susceptible staphylococcus aureus infection
  • Preferred regimen: Vancomycin
  • Note (1): Preoperative antibiotics should be administered to all patients to reduce the risk of mediastinitis in cardiac surgery.
  • Note (2): A deep sternal wound infection should be treated with aggressive surgical debridement in the absence of complicating circumstances.
  • Note (3): Primary or secondary closure with muscle or omental flap is recommended. Vacuum therapy in conjunction with early and aggressive debridement is an effective adjunctive therapy.
  • Note (4): 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.
  • Note (5): The use of intranasal mupirocin is reasonable in nasal carriers of S. aureus.

Myocarditis, viral

Treatment[3]

  • Note (3): ICD implantation is not indicated during the acute phase of myocarditis.
  • Note (4): ICD implantation can be beneficial in patients with life-threatening ventricular arrhythmias who are not in the acute phase of myocarditis, as indicated in the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices.
  • Note (5): Antiarrhythmic therapy can be useful in patients with symptomatic NSVT or sustained VT during the acute phase of myocarditis.

Pericarditis, fungal

  • Fungal Pericarditis[4]
Note: Corticosteroids and NSAIDs can support the treatment with antifungal drugs. Pericardiocentesis or surgical treatment is indicated for haemodynamic impairment. Pericardiectomy is indicated in fungal constrictive pericarditis.
Note: Corticosteroids and NSAIDs can support the treatment with antifungal drugs. Pericardiocentesis or surgical treatment is indicated for haemodynamic impairment. Pericardiectomy is indicated in fungal constrictive pericarditis.
  • Preferred regimen: Combination of three antibiotics including Penicillin.
Note: Corticosteroids and NSAIDs can support the treatment with antifungal drugs. Pericardiocentesis or surgical treatment is indicated for haemodynamic impairment. Pericardiectomy is indicated in fungal constrictive pericarditis.

Pericarditis, tuberculous

Note: Intrapericardial drainage is done if needed. If constriction develops inspite of medical therapy, pericardiectomy is indicated.[4].

Pericarditis, viral

  • Viral pericarditis[4]
  • CMV pericarditis
  • Preferred regimen: immunoglobulin 1 time per day 4 ml/kg on day 0, 4, and 8; 2 ml/kg on day 12 and 16.
Note: Symptomatic treatment is given to the patients with viral pericarditis while in large effusions and cardiac tamponade pericardiocentesis is necessary. The use of corticosteroid therapy is contraindicated except in patients with secondary tuberculous pericarditis, as an adjunct to tuberculosis treatment. Drainage, if needed is done.
  • Coxsackie B pericarditis
  • Preferred regimen: Interferon alpha or beta 2,5 Mio. IU/m2 surface area s.c. 3 times per week
Note: Symptomatic treatment is given to the patients with viral pericarditis while in large effusions and cardiac tamponade pericardiocentesis is necessary. The use of corticosteroid therapy is contraindicated except in patients with secondary tuberculous pericarditis, as an adjunct to tuberculosis treatment. Drainage, if needed is done.
  • Adenovirus and parvovirus B19 perimyocarditis
  • Preferred regimen: Immunoglobulin 10 g IV at day 1 and 3 for 6–8 hours
Note: Symptomatic treatment is given to the patients with viral pericarditis while in large effusions and cardiac tamponade pericardiocentesis is necessary. The use of corticosteroid therapy is contraindicated except in patients with secondary tuberculous pericarditis, as an adjunct to tuberculosis treatment. Drainage, if needed is done.

Rheumatic fever, primary prophylaxis

Rheumatic fever, secondary prophylaxis

Septic pelvic vein thrombophlebitis

  • 1. Right ovarian vein thrombosis
  • 2. Pelvic branch vein thrombosis
  • 3. Negative for pelvic thrombi

References

  1. ↑ Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMC 4039170. PMID 19489710.
  2. ↑ Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "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. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons". J Am Coll Cardiol. 58 (24): e123–210. doi:10.1016/j.jacc.2011.08.009. PMID 22070836.
  3. ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0443068393.
  4. ↑ 4.0 4.1 4.2 Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y; et al. (2004). "Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology". Eur Heart J. 25 (7): 587–610. doi:10.1016/j.ehj.2004.02.002. PMID 15120056.
  5. ↑ Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN; et al. (2003). "American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis". Am J Respir Crit Care Med. 167 (4): 603–62. doi:10.1164/rccm.167.4.603. PMID 12588714.
  6. ↑ Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST; et al. (2009). "Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics". Circulation. 119 (11): 1541–51. doi:10.1161/CIRCULATIONAHA.109.191959. PMID 19246689.
  7. ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 63 (22): e57–185. doi:10.1016/j.jacc.2014.02.536. PMID 24603191.
  8. ↑ Javier Garcia, Ramzi Aboujaoude, Joseph Apuzzio & Jesus R. Alvarez (2006). "Septic pelvic thrombophlebitis: diagnosis and management". Infectious diseases in obstetrics and gynecology. 2006: 15614. doi:10.1155/IDOG/2006/15614. PMID 17485796.
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