Mediastinitis medical therapy
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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
- 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.