India Antibiotic Guideline For Post Cardiovascular Surgery Infections
In 2016, National Centre For Disease Control, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India came out with National Treatment Guidelines for Antimicrobial Use in Infectious Diseases.
Following are major recommendations
Post-Cardiovascular Surgery Infections :
Surveillance regarding the Infections following CTVS should be done in each institute
1. Antibiotic Prophylaxis to be guided by the institutional prevalence of MRSA infection and in patients at increased risk for MRSA colonization
2. Nasal screening before CTV surgery is recommended to rule out MRSA colonization
| S. no. | Surgery | Antibiotic Prophylaxis | Comments |
| 1 st line | 2 nd line | Special Antibiotic/Combination |
| 1. | CABG | Cefazolin | Cefuroxime | - | Vancomycin /Teicoplanin to be used in case of high prevalence of MRSA infections only Using only Vancomycin/Teicoplanin is NOT recommended due to lack of coverage of GNB Vancomycin infusion to be given over 1 hour & to be started 2 hrs before the surgical incision Teicoplanin dosing to start with 800 mg x 3 doses and then 6 mg/kg to complete prophylxis Duration of Prophylaxis: Continued till 48 hours after the surgery |
Empirical Treatment after appropriate specimen for stain & cultures have been collected
| S. no | Infection/ Syndrome | Likely Causative agents | Antibiotics | Comments |
| 1 st line | 2 nd line | Special Antibiotic/ Combination | ||||
| 1 | Sternotomy site infection | Not known | BL-BLI (Piperacillin-tazobactam, Cefoperazone-sulbactam, cefipime-tazobactam) with or without amikacin. With Vancomycin/ teicoplanin | Daptomycin/ Linezolid with carbapenem | Consider deescalation to TMP/SMX , doxy/minocycline, cloxacillin, cefazolin, If these are sensitive | 1) Removal of the foreign body (steel wires) should be considered |
| 2 | Infection of vascular catheters | Not known | BL-BLI (Piperacillin-tazobactam, Cefoperazone-sulbactam, cefipime-tazobactam) with or without amikacin with Vancomycin/ teicoplanin | Carbapenem (Empirical anti-MRSA drug if the incidence of MRSA CRBSI is high) | Consider de-escalation as per the isolate, susceptibility, MICs, adverse effects, drug allergy | |
| 3 | Pneumonia | Not known | BL-BLI (Piperacillin-tazobactam, Cefoperazone-sulbactam) with or without amikacin | Carbapenem | Consider de-escalation as per the isolate, susceptibility, MICs, adverse effects, drug allergy | |
| 4 | Mediastinitis | Not known | BL-BLI (Piperacillin-tazobactam, Cefoperazone-sulbactam) with or without amikacin With Vancomycin/ teicoplanin | Carbapenem with or without Amikacin | Consider de-escalation as per the isolate, | |
| 5 | Urinary tract infection | Not known | BL-BLI (Piperacillin-tazobactam, Cefoperazone-sulbactam with or without amikacin | Carbapenem with or without Amikacin | Consider de-escalation as per the isolate, susceptibility, MICs, adverse effects, drug allergy |
Definitive Treatment after appropriate specimen for stain & cultures have been collected
| S. no | Infection/ Syndrome | Likely Causative agents | Antibiotics | Comments |
| 1 | Sternotomy site infection | Coagulase Negative Staphylococc i | Vancomycin, Teicoplanin | Daptomycin Linezolid | Consider de-escalation to Cotrimoxazole or Cloxacillin or Cefazolin Consider de-escalation to TMP/SMX or doxy/minocycline If these are sensitive | 1) Consider MICs, risk of nephrotoxicity , bone penetration for choosing the antibiotic 2) Removal of |
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