Cardiothoracic surgery infections (post-op)
Sternal wound infection - post sternotomy
Includes sternal wound infection, vein/artery graft site infection and groin wound infection
- Send blood and pus cultures and tissue samples from surgical debridement for culture
- Surgical exploration and debridement is indicated for sternal wound infections where deep or complicated infection is suspected.
- Consult Micro/ID
Duration: Typically for superficial infection 3-5 days. If deep infection suspected discuss with Micro/ID and consider sternal and mediastinal imaging.
Preferred
flucloxacillin 2g iv qds
If severe sepsis or septic shock: ADD gentamicin 5mg/kg iv single dose and consult Micro/ID. If creatinine clearance less than 30 ml/min reduce dose to 3mg/kg.
Oral switch: flucloxacillin 1g po qds
Alternative
Consider penicillin allergy assessment and delabelling
For penicillin allergy (non-severe)
cefazolin 2g iv tds
If severe sepsis or septic shock: ADD gentamicin 5mg/kg iv single dose and consult Micro/ID. If creatinine clearance less than 30 ml/min reduce dose to 3mg/kg.
Oral switch: cefalexin 1g po tds
For penicillin allergy (severe) OR MRSA positive
co-trimoxazole 960mg po bd (iv if NBM)
If severe sepsis or septic shock: ADD gentamicin 5mg/kg iv single dose and consult Micro/ID. If creatinine clearance less than 30 ml/min reduce dose to 3mg/kg.