Cardiac surgery antibiotic prophylaxis and calculated empiric antibiotic therapy

Gorski, Armin; Hamouda, K.; Özkur, M.; Leistner, Markus; Sommer, Sebastian; Leyh, Rainer; Schimmer, Christoph

doi:10.1177/0218492314546028

Cited by 10 publications

(11 citation statements)

References 27 publications

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“…No specific risk factor was identified for Acinetobacter species-related early BSI in our patients, and Acinetobacter species-related BSI did not lead to a worse outcome. Efforts to reduce the incidence of Acinetobacter species-related BSI are identical to those widely accepted practical bundles, such as full barrier precautions for central catheters and avoiding unnecessary central venous catheters [6,16]. Nevertheless, efforts to prevent and adequately treat Enterobacteriaceaerelated BSI after cardiovascular operations should be emphasized and might require adjustments.…”

Section: Commentmentioning

confidence: 99%

“…An associated operative mortality rate of up to 40% has also been reported when a bloodstream infection (BSI) develops in patients undergoing cardiovascular operations [3]. Many risk factors for postoperative infection after cardiovascular surgery using CPB have been identified, such as older age, diabetes mellitus, obesity, emergency operation, multiple blood transfusions, postoperative low cardiac output, and use of mechanical circulatory supporting devices [4,6]. Besides, use of CPB itself could be a theoretical risk factor for infection after a cardiovascular operation as a result of the increased blood transfusion and immunomodulatory effect of CPB.…”

mentioning

confidence: 99%

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Cardiopulmonary Bypass Time Predicts Early Postoperative Enterobacteriaceae Bloodstream Infection

Wang

Luo

et al. 2019

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

Cardiopulmonary Bypass Time Predicts Early Postoperative Enterobacteriaceae Bloodstream Infection

Wang

Luo

et al. 2019

The Annals of Thoracic Surgery

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“…Interestingly, we know from experience that some patients develop fever and hemodynamic instability after cardiac surgery without definitive etiological evidence. Previous studies have shown that systemic inflammatory response syndrome and postoperative fever are complications that develop after cardiac surgery (3,4). We speculate that fever of unknown origin (FUO) and hemodynamic instability are related to systemic inflammatory response syndrome or sepsis.…”

Section: Introductionmentioning

confidence: 80%

“…However, they may not be. The use of CPB or extracorporeal life support (ECLS) to support a patient during an intraoperative thoracic surgery is common, and cardiopulmonary bypass (CPB) is one of the risk factors for infection in patients undergoing cardiac surgery ( 5 ). On the one hand, it is reported that most of the early bloodstream infections of patients undergoing CPB are caused by gram-negative bacteria, which are commonly present in the intestinal flora ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical Multi-Omics Study on the Gut Microbiota in Critically Ill Patients After Cardiovascular Surgery Combined With Cardiopulmonary Bypass With or Without Sepsis (MUL-GM-CSCPB Study): A Prospective Study Protocol

et al. 2020

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Introduction: Fever of unknown origin (FUO) and hemodynamic instability are complications that develop after cardiac surgery combined with cardiopulmonary bypass (CPB) for heart disease. Patients who develop fever with hemodynamic instability after cardiac surgery may have systemic inflammatory response syndrome or sepsis. Cardiopulmonary bypass (CPB) is a technique that temporarily takes over the function of the heart and lungs during cardiac surgery. Recent reports suggest that early bloodstream infections of patients undergoing CPB are due to gram-negative bacteria that are present in the intestinal flora. The theory of intestinal flora translocation has growing evidence. Intestinal ischemia-reperfusion that occurs during cardiac surgery with CPB will induce a systemic inflammatory reaction and may cause intestinal flora translocation. Does this systemic reaction cause sepsis? We therefore propose this protocol to determine whether the changes in the intestinal flora in patients after cardiac surgery with CPB are related to sepsis. Methods and Analysis: This study is a prospective observational case-control study to analyze the variation in the intestinal microflora and metabolites in patients undergoing cardiac surgery with CPB and to observe the outcomes of patients with routine clinical interventions. The control group will include healthy people without intestinal illness. Feces and blood samples will be acquired 1 day before cardiac surgery and within 24-72 h after cardiac surgery, and will be used for genomics and metabolomics analyses. Demographic data describing age, sex, main diagnosis, and past medical history and data related to the CPB time and application of antibiotics are available. Sequential (sepsis-related) organ failure assessment, infection-related laboratory items, infection site, and pathogenic microorganisms, and nutrition, and Ding et al. Multi-Omics on Cardiovascular Surgery Combined CPB gastrointestinal function assessment are additionally recorded. Group analysis of data will be conducted according to the outcomes (sepsis vs. non-sepsis and survivors vs. non-survivors). Ethics and Dissemination: This protocol has been ethically approved by the Ethics Committee of Peking Union Medical College (ID: ZS-1612). Informed consent will be obtained before subject enrolment, and data will be stored in a secured database. The results will be submitted to international peer-reviewed journals and presented at international conferences. Trial Registration Number: NCT04032938.

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“…The diagnosis of postoperative infection in cardiac surgery patients may be complicated due to the difficulty in distinguishing the symptoms of infection from a systemic inflammatory response caused by extensive tissue damage or the use of cardiopulmonary bypass during surgery [ 10 ]. The clinical symptoms of SSI in cardiac surgery patients vary depending on the type of infection.…”

Section: Clinical Symptoms Of Ssismentioning

confidence: 99%

Surgical Site Infection in Cardiac Surgery

Żukowska¹,

Żukowski

2022

JCM

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Surgical site infections (SSIs) are one of the most significant complications in surgical patients and are strongly associated with poorer prognosis. Due to their aggressive character, cardiac surgical procedures carry a particular high risk of postoperative infection, with infection incidence rates ranging from a reported 3.5% and 26.8% in cardiac surgery patients. Given the specific nature of cardiac surgical procedures, sternal wound and graft harvesting site infections are the most common SSIs. Undoubtedly, DSWIs, including mediastinitis, in cardiac surgery patients remain a significant clinical problem as they are associated with increased hospital stay, substantial medical costs and high mortality, ranging from 3% to 20%. In SSI prevention, it is important to implement procedures reducing preoperative risk factors, such as: obesity, hypoalbuminemia, abnormal glucose levels, smoking and S. aureus carriage. For decolonisation of S. aureus carriers prior to cardiac surgery, it is recommended to administer nasal mupirocin, together with baths using chlorhexidine-based agents. Perioperative management also involves antibiotic prophylaxis, surgical site preparation, topical antibiotic administration and the maintenance of normal glucose levels. SSI treatment involves surgical intervention, NPWT application and antibiotic therapy

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Cardiac surgery antibiotic prophylaxis and calculated empiric antibiotic therapy

Abstract: This survey shows that existing national guidelines and recommendations concerning perioperative antibiotic prophylaxis and calculated empiric antibiotic therapy are well applied in almost all German heart centers.

Cited by 10 publications

References 27 publications

Cardiopulmonary Bypass Time Predicts Early Postoperative Enterobacteriaceae Bloodstream Infection

Cardiopulmonary Bypass Time Predicts Early Postoperative Enterobacteriaceae Bloodstream Infection

Clinical Multi-Omics Study on the Gut Microbiota in Critically Ill Patients After Cardiovascular Surgery Combined With Cardiopulmonary Bypass With or Without Sepsis (MUL-GM-CSCPB Study): A Prospective Study Protocol

Surgical Site Infection in Cardiac Surgery

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