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India Antibiotic Guideline For Post Cardiovascular Surgery Infections


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

 

You can read the full Guideline by clicking on the following link :

http://www.ncdc.gov.in/writereaddata/linkimages/AMR_guideline7001495889.pdf

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supriya kashyap

supriya kashyap

Supriya Kashyap Joined Medical Dialogue as Reporter in 2015 . she covers all the medical specialty news in different medical categories. She also covers the Medical guidelines, Medical Journals, rare medical surgeries as well as all the updates in medical filed. She is a graduate from Delhi University. She can be contacted at supriya.kashyap@medicaldialogues.in Contact no. 011-43720751
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