[Guideline of antimicrobial therapy in the area of cardiovascular surgery]

Although cardiovascular surgery is considered to be aseptic, prolonged hospital stay before and after surgery, the use of artificial materials and cardiopulmonary bypass, long-term use of intratracheal tubes or intravenous catheters, and an increase in surgeries on high-risk patients increase the incidence of postoperative infections. Therefore meticulous management to minimize bacterial contamination before and after surgery and identification of patient risk factors are important to reduce their incidence and severity, in addition to optimal antimicrobial therapy. As the targets of prophylactic antibiotics are usually superficial and environmental bacteria, those of choice are first or second-generation cephalosporins or penicillin with sulbactam. If postoperative infection is suspected, identification of the infectious site and pathogens and their susceptibility to anitimicrobials is useful to control infections. The use of broad-spectrum antibiotics is not recommended because these drugs induce bacterial resistance to antibiotics. Infectious endocarditis (IE) and deep wound infections, such as mediastinitis, are major serious infections after cardiovascular surgery. Antibiotics should be selected by considering the susceptibility of pathogens and pharmacokinetic properties of antibiotics, such as concentration in infected tissue. In patients reluctant to medical therapies, surgical intervention such as valve repair or replacement in IE and debridement and omental flap in mediastinitis should be considered.