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Coronary artery bypass surgery management of perioperative infection

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

  1. ↑ 1.0 1.1 1.2 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”. Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
  2. ↑ Kreter B, Woods M (1992). “Antibiotic prophylaxis for cardiothoracic operations. Meta-analysis of thirty years of clinical trials”. The Journal of Thoracic and Cardiovascular Surgery. 104 (3): 590–9. PMID 1387437. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  3. ↑ Goodman JS, Schaffner W, Collins HA, Battersby EJ, Koenig MG (1968). “Infection after cardiovascular surgery. Clinical study including examination of antimicrobial prophylaxis”. The New England Journal of Medicine. 278 (3): 117–23. doi:10.1056/NEJM196801182780301. PMID 4965378. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  4. ↑ Fong IW, Baker CB, McKee DC (1979). “The value of prophylactic antibiotics in aorat-coronary bypass operations: a double-blind randomized trial”. The Journal of Thoracic and Cardiovascular Surgery. 78 (6): 908–13. PMID 388085. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  5. ↑ Fekety FR, Cluff LE, Sabiston DC, Seidl LG, Smith JW, Thoburn R (1969). “A study of antibiotic prophylaxis in cardiac surgery”. The Journal of Thoracic and Cardiovascular Surgery. 57 (6): 757–63. PMID 5770455. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  6. ↑ 6.0 6.1 Kaiser AB, Petracek MR, Lea JW, Kernodle DS, Roach AC, Alford WC, Burrus GR, Glassford DM, Thomas CS, Stoney WS (1987). “Efficacy of cefazolin, cefamandole, and gentamicin as prophylactic agents in cardiac surgery. Results of a prospective, randomized, double-blind trial in 1030 patients”. Annals of Surgery. 206 (6): 791–7. PMC 1493322. PMID 3689015. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  7. ↑ Austin TW, Coles JC, Burnett R, Goldbach M (1980). “Aortocoronary bypass procedures and sternotomy infections: a study of antistaphylococcal prophylaxis”. Canadian Journal of Surgery. Journal Canadien De Chirurgie. 23 (5): 483–5. PMID 6969109. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  8. ↑ Bolon MK, Morlote M, Weber SG, Koplan B, Carmeli Y, Wright SB (2004). “Glycopeptides are no more effective than beta-lactam agents for prevention of surgical site infection after cardiac surgery: a meta-analysis”. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 38 (10): 1357–63. doi:10.1086/383318. PMID 15156470. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  9. ↑ Finkelstein R, Rabino G, Mashiah T, Bar-El Y, Adler Z, Kertzman V, Cohen O, Milo S (2002). “Vancomycin versus cefazolin prophylaxis for cardiac surgery in the setting of a high prevalence of methicillin-resistant staphylococcal infections”. The Journal of Thoracic and Cardiovascular Surgery. 123 (2): 326–32. PMID 11828293. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  10. ↑ 10.0 10.1 Maki DG, Bohn MJ, Stolz SM, Kroncke GM, Acher CW, Myerowitz PD (1992). “Comparative study of cefazolin, cefamandole, and vancomycin for surgical prophylaxis in cardiac and vascular operations. A double-blind randomized trial”. The Journal of Thoracic and Cardiovascular Surgery. 104 (5): 1423–34. PMID 1434726. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  11. ↑ Saginur R, Croteau D, Bergeron MG (2000). “Comparative efficacy of teicoplanin and cefazolin for cardiac operation prophylaxis in 3027 patients. The ESPRIT Group”. The Journal of Thoracic and Cardiovascular Surgery. 120 (6): 1120–30. PMID 11088036. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  12. ↑ Salminen US, Viljanen TU, Valtonen VV, Ikonen TE, Sahlman AE, Harjula AL (1999). “Ceftriaxone versus vancomycin prophylaxis in cardiovascular surgery”. The Journal of Antimicrobial Chemotherapy. 44 (2): 287–90. PMID 10473238. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  13. ↑ Townsend TR, Reitz BA, Bilker WB, Bartlett JG (1993). “Clinical trial of cefamandole, cefazolin, and cefuroxime for antibiotic prophylaxis in cardiac operations”. The Journal of Thoracic and Cardiovascular Surgery. 106 (4): 664–70. PMID 8412261. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  14. ↑ Vuorisalo S, Pokela R, Syrjälä H (1998). “Comparison of vancomycin and cefuroxime for infection prophylaxis in coronary artery bypass surgery”. Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America. 19 (4): 234–9. PMID 9605271. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  15. ↑ Wilson AP, Treasure T, Grüneberg RN, Sturridge MF, Ross DN (1988). “Antibiotic prophylaxis in cardiac surgery: a prospective comparison of two dosage regimens of teicoplanin with a combination of flucloxacillin and tobramycin”. The Journal of Antimicrobial Chemotherapy. 21 (2): 213–23. PMID 2966140. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  16. ↑ “Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC)”. MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports / Centers for Disease Control. 44 (RR-12): 1–13. 1995. PMID 7565541. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  17. ↑ Walsh EE, Greene L, Kirshner R (2011). “Sustained reduction in methicillin-resistant Staphylococcus aureus wound infections after cardiothoracic surgery”. Archives of Internal Medicine. 171 (1): 68–73. doi:10.1001/archinternmed.2010.326. PMID 20837818. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  18. ↑ Spelman D, Harrington G, Russo P, Wesselingh S (2002). “Clinical, microbiological, and economic benefit of a change in antibiotic prophylaxis for cardiac surgery”. Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America. 23 (7): 402–4. doi:10.1086/502074. PMID 12138981. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  19. ↑ Jurkiewicz MJ, Bostwick J, Hester TR, Bishop JB, Craver J (1980). “Infected median sternotomy wound. Successful treatment by muscle flaps”. Annals of Surgery. 191 (6): 738–44. PMC 1344786. PMID 7387236. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  20. ↑ Rand RP, Cochran RP, Aziz S, Hofer BO, Allen MD, Verrier ED, Kunzelman KS (1998). “Prospective trial of catheter irrigation and muscle flaps for sternal wound infection”. The Annals of Thoracic Surgery. 65 (4): 1046–9. PMID 9564925. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  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)
  22. ↑ Argenta LC, Morykwas MJ (1997). “Vacuum-assisted closure: a new method for wound control and treatment: clinical experience”. Annals of Plastic Surgery. 38 (6): 563–76, discussion 577. PMID 9188971. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  23. ↑ Baillot R, Cloutier D, Montalin L, Côté L, Lellouche F, Houde C, Gaudreau G, Voisine P (2010). “Impact of deep sternal wound infection management with vacuum-assisted closure therapy followed by sternal osteosynthesis: a 15-year review of 23,499 sternotomies”. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 37 (4): 880–7. doi:10.1016/j.ejcts.2009.09.023. PMID 19880326. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  24. ↑ Cowan KN, Teague L, Sue SC, Mahoney JL (2005). “Vacuum-assisted wound closure of deep sternal infections in high-risk patients after cardiac surgery”. The Annals of Thoracic Surgery. 80 (6): 2205–12. doi:10.1016/j.athoracsur.2005.04.005. PMID 16305872. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  25. ↑ Doss M, Martens S, Wood JP, Wolff JD, Baier C, Moritz A (2002). “Vacuum-assisted suction drainage versus conventional treatment in the management of poststernotomy osteomyelitis”. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 22 (6): 934–8. PMID 12467816. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  26. ↑ Ennker IC, Malkoc A, Pietrowski D, Vogt PM, Ennker J, Albert A (2009). “The concept of negative pressure wound therapy (NPWT) after poststernotomy mediastinitis–a single center experience with 54 patients”. Journal of Cardiothoracic Surgery. 4: 5. doi:10.1186/1749-8090-4-5. PMC 3225867. PMID 19138422. Retrieved 2011-12-16.
  27. ↑ Fleck T, Moidl R, Giovanoli P, Aszmann O, Bartunek A, Blacky A, Grabenwoger M, Wolner E (2006). “A conclusion from the first 125 patients treated with the vacuum assisted closure system for postoperative sternal wound infection”. Interactive Cardiovascular and Thoracic Surgery. 5 (2): 145–8. doi:10.1510/icvts.2005.122804. PMID 17670536. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  28. ↑ Fleck TM, Fleck M, Moidl R, Czerny M, Koller R, Giovanoli P, Hiesmayer MJ, Zimpfer D, Wolner E, Grabenwoger M (2002). “The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery”. The Annals of Thoracic Surgery. 74 (5): 1596–600, discussion 1600. PMID 12440614. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  29. ↑ Luckraz H, Murphy F, Bryant S, Charman SC, Ritchie AJ (2003). “Vacuum-assisted closure as a treatment modality for infections after cardiac surgery”. The Journal of Thoracic and Cardiovascular Surgery. 125 (2): 301–5. doi:10.1067/mtc.2003.74. PMID 12579098. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  30. ↑ Sjögren J, Gustafsson R, Nilsson J, Malmsjö M, Ingemansson R (2005). “Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional treatment”. The Annals of Thoracic Surgery. 79 (6): 2049–55. doi:10.1016/j.athoracsur.2004.12.048. PMID 15919308. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  31. ↑ Sjögren J, Nilsson J, Gustafsson R, Malmsjö M, Ingemansson R (2005). “The impact of vacuum-assisted closure on long-term survival after post-sternotomy mediastinitis”. The Annals of Thoracic Surgery. 80 (4): 1270–5. doi:10.1016/j.athoracsur.2005.04.010. PMID 16181853. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  32. ↑ van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R (2001). “Intensive insulin therapy in the critically ill patients”. The New England Journal of Medicine. 345 (19): 1359–67. doi:10.1056/NEJMoa011300. PMID 11794168. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  33. ↑ Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O’Brien PC, Johnson MG, Williams AR, Cutshall SM, Mundy LM, Rizza RA, McMahon MM (2007). “Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial”. Annals of Internal Medicine. 146 (4): 233–43. PMID 17310047. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  34. ↑ Ouattara A, Lecomte P, Le Manach Y, Landi M, Jacqueminet S, Platonov I, Bonnet N, Riou B, Coriat P (2005). “Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients”. Anesthesiology. 103 (4): 687–94. PMID 16192760. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  35. ↑ Doenst T, Wijeysundera D, Karkouti K, Zechner C, Maganti M, Rao V, Borger MA (2005). “Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery”. The Journal of Thoracic and Cardiovascular Surgery. 130 (4): 1144. doi:10.1016/j.jtcvs.2005.05.049. PMID 16214532. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  36. ↑ Furnary AP, Wu Y (2006). “Eliminating the diabetic disadvantage: the Portland Diabetic Project”. Seminars in Thoracic and Cardiovascular Surgery. 18 (4): 302–8. doi:10.1053/j.semtcvs.2006.04.005. PMID 17395026. Retrieved 2011-12-19.
  37. ↑ Kirdemir P, Yildirim V, Kiris I, Gulmen S, Kuralay E, Ibrisim E, Ozal E (2008). “Does continuous insulin therapy reduce postoperative supraventricular tachycardia incidence after coronary artery bypass operations in diabetic patients?”. Journal of Cardiothoracic and Vascular Anesthesia. 22 (3): 383–7. doi:10.1053/j.jvca.2007.09.015. PMID 18503925. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  38. ↑ Bilgin YM, van de Watering LM, Eijsman L, Versteegh MI, Brand R, van Oers MH, Brand A (2004). “Double-blind, randomized controlled trial on the effect of leukocyte-depleted erythrocyte transfusions in cardiac valve surgery”. Circulation. 109 (22): 2755–60. doi:10.1161/01.CIR.0000130162.11925.21. PMID 15148271. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  39. ↑ Blumberg N, Heal JM, Cowles JW, Hicks GL, Risher WH, Samuel PK, Kirkley SA (2002). “Leukocyte-reduced transfusions in cardiac surgery results of an implementation trial”. American Journal of Clinical Pathology. 118 (3): 376–81. doi:10.1309/79B7-2QWN-AG8W-HBHD. PMID 12219779. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  40. ↑ Romano G, Mastroianni C, Bancone C, Della Corte A, Galdieri N, Nappi G, De Santo LS (2010). “Leukoreduction program for red blood cell transfusions in coronary surgery: association with reduced acute kidney injury and in-hospital mortality”. The Journal of Thoracic and Cardiovascular Surgery. 140 (1): 188–95. doi:10.1016/j.jtcvs.2010.03.022. PMID 20416894. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  41. ↑ van de Watering LM, Hermans J, Houbiers JG, van den Broek PJ, Bouter H, Boer F, Harvey MS, Huysmans HA, Brand A (1998). “Beneficial effects of leukocyte depletion of transfused blood on postoperative complications in patients undergoing cardiac surgery: a randomized clinical trial”. Circulation. 97 (6): 562–8. PMID 9494026. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  42. ↑ Konvalinka A, Errett L, Fong IW (2006). “Impact of treating Staphylococcus aureus nasal carriers on wound infections in cardiac surgery”. The Journal of Hospital Infection. 64 (2): 162–8. doi:10.1016/j.jhin.2006.06.010. PMID 16930768. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  43. ↑ van Rijen M, Bonten M, Wenzel R, Kluytmans J (2008). “Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers”. Cochrane Database of Systematic Reviews (Online) (4): CD006216. doi:10.1002/14651858.CD006216.pub2. PMID 18843708. Retrieved 2011-12-19.

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