Mediastinitis medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
===Antimicrobial Regimen=== | ===Antimicrobial Regimen=== | ||
* '''Treatment secondary to cardiac infection and surgery'''<ref name="pmid22070836">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=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. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 24 | pages= e123-210 | pmid=22070836 | doi=10.1016/j.jacc.2011.08.009 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22070836 }} </ref>. | *Acute mediastinitis treatment | ||
:* Preferred regimen: [[Clindamycin]] 450 mg IV q6h {{and}} [[Ceftriaxone]] 2 g IV q24h, for at least 2 weeks | :* '''Treatment secondary to cardiac infection and surgery'''<ref name="pmid22070836">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=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. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 24 | pages= e123-210 | pmid=22070836 | doi=10.1016/j.jacc.2011.08.009 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22070836 }} </ref>. | ||
* '''Prophylaxis''' | ::* Preferred regimen: [[Clindamycin]] 450 mg IV q6h {{and}} [[Ceftriaxone]] 2 g IV q24h, for at least 2 weeks | ||
:* '''Methicillin susceptible staphylococcus aureus infection''' | :* '''Prophylaxis''' | ||
::* Preferred regimen: Second generation [[cephalosporin]]. | ::* '''Methicillin susceptible staphylococcus aureus infection''' | ||
:* '''Methicillin susceptible staphylococcus aureus infection''' | :::* Preferred regimen: Second generation [[cephalosporin]]. | ||
::* Preferred regimen: [[Vancomycin]] | ::* '''Methicillin susceptible staphylococcus aureus infection''' | ||
::* Note (1): Preoperative [[antibiotics]] should be administered to all patients to reduce the risk of [[mediastinitis]] in cardiac surgery. | :::* Preferred regimen: [[Vancomycin]] | ||
::* Note (2): A deep sternal wound [[infection]] should be treated with aggressive surgical [[debridement]] in the absence of complicating circumstances. | :::* Note (1): Preoperative [[antibiotics]] should be administered to all patients to reduce the risk of [[mediastinitis]] in cardiac surgery. | ||
::* 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 (2): A deep sternal wound [[infection]] should be treated with aggressive surgical [[debridement]] in the absence of complicating circumstances. | ||
::* 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 (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 (5): The use of intranasal [[mupirocin]] is reasonable in nasal carriers of [[S. aureus]]. | :::* 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]]. | |||
==References== | ==References== | ||
Revision as of 15:50, 14 August 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The mainstay of therapy in acute mediastinitis includes Clindamycin and Ceftriaxone. The preferred regimen for prophylaxis against acute mediastinitis includes either Vancomycin or a second generation Cephalosporin.
Medical Therapy
Antimicrobial Regimen
- Acute mediastinitis treatment
- Treatment secondary to cardiac infection and surgery[1].
- Preferred regimen: Clindamycin 450 mg IV q6h AND Ceftriaxone 2 g IV q24h, for at least 2 weeks
- Prophylaxis
- Methicillin susceptible staphylococcus aureus infection
- Preferred regimen: Second generation cephalosporin.
- 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.
References
- ↑ 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.