Mediastinitis medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
===Antimicrobial | ===Antimicrobial Regimens=== | ||
* '''1. Post-cardiothoracic surgery mediastinitis'''<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> | * '''1. Post-cardiothoracic surgery mediastinitis'''<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> | ||
:* '''1.1 Treatment''' | :* '''1.1 Treatment''' | ||
Revision as of 14:50, 18 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 Regimens
- 1. Post-cardiothoracic surgery mediastinitis[1]
- 1.1 Treatment
- Preferred regimen: Clindamycin 450 mg IV q6h AND Ceftriaxone 2 g IV q24h, for at least 2 weeks
- Note: A deep sternal wound infection should be treated with aggressive surgical debridement in the absence of complicating circumstances.
- 1.2 Prophylaxis
- 1.2.1 Methicillin susceptible staphylococcus aureus infection
- Preferred regimen: Second generation cephalosporin
- 1.2.2 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): The use of intranasal mupirocin is reasonable in nasal carriers of S. aureus.
- 2. Descending necrotizing mediastinitis
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.