What is the treatment for post-operative Coronary Artery Bypass Graft (CABG) wound infection?

From the Guidelines

The treatment for post-operative CABG wound infection requires prompt intervention with antibiotics and surgical management, with a focus on empiric broad-spectrum antibiotics such as vancomycin and piperacillin-tazobactam, adjusted based on culture results, and continued for 2-6 weeks depending on infection severity, as recommended by the Infectious Diseases Society of America 1. The initial treatment involves empiric broad-spectrum antibiotics, which should be adjusted based on culture results and continued for 2-6 weeks depending on infection severity.

• Surgical debridement is essential to remove infected and necrotic tissue, with options ranging from local wound care for superficial infections to more extensive procedures like sternal debridement, mediastinal drainage, or sternal reconstruction for deep sternal wound infections.
• Vacuum-assisted closure therapy is often used following debridement, applying negative pressure (typically 125 mmHg) to promote healing.
• Nutritional support is crucial, with high-protein supplements and blood glucose control (target 140-180 mg/dL) to optimize healing, as supported by the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines 1.
• Wound care includes regular dressing changes using antiseptic solutions like chlorhexidine. These infections require aggressive management because the mediastinum's proximity to vital structures makes infections potentially life-threatening, with mortality rates of 10-40% for deep sternal wound infections. Treatment should be tailored to infection depth, causative organisms, and patient factors, with a multidisciplinary approach involving cardiac surgeons, infectious disease specialists, and wound care experts, and considering the latest guidelines on pre-operative decolonization and targeted prophylaxis in patients colonized by multidrug-resistant gram-positive bacteria before surgery 1.

From the FDA Drug Label

The prophylactic administration of Cefazolin for Injection, USP preoperatively, intraoperatively, and postoperatively may reduce the incidence of certain postoperative infections in patients undergoing surgical procedures which are classified as contaminated or potentially contaminated (e.g., vaginal hysterectomy and cholecystectomy in high-risk patients such as those older than 70 years, with acute cholecystitis, obstructive jaundice, or common duct bile stones). The perioperative use of Cefazolin for Injection, USP also may be effective in surgical patients in whom infection at the operative site would present a serious risk (e.g., during open-heart surgery and prosthetic arthroplasty).

The treatment for post-operative Coronary Artery Bypass Graft (CABG) wound infection may include cefazolin as it is indicated for the treatment of serious infections due to susceptible organisms, including Skin and Skin Structure Infections. However, the choice of treatment should be based on the results of culture and susceptibility studies to determine the effectiveness of cefazolin against the causative organism 2.

• The treatment should be guided by the identification of the causative organism and the susceptibility patterns of the organism to cefazolin.
• In the absence of culture and susceptibility data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

From the Research

Post-Operative CABG Wound Infection Treatment

The treatment for post-operative Coronary Artery Bypass Graft (CABG) wound infection is crucial to prevent further complications and promote healing.

• The management of postoperative wound infections involves identifying the causative organisms and administering appropriate antibiotic therapy 3.
• In addition to antibiotic therapy, proper wound care and dressing are essential to promote healing and prevent further infection.
• The use of triclosan-coated sutures has been shown to reduce the incidence of wound infection, although the differences were not statistically significant 4.
• Early exposure method of wound care, where the wound is left undressed on the 4th postoperative day, has been proposed as a method to prevent wound infections 5.

Risk Factors for Post-Operative CABG Wound Infection

Several risk factors have been identified for post-operative CABG wound infection, including:

• Obesity 3
• Diabetes mellitus 3
• Female sex 3
• Sternal site infection 3
• Leg site infection 3, 6

Prevention of Post-Operative CABG Wound Infection

Prevention of post-operative CABG wound infection is crucial to reduce morbidity and mortality.

• The use of antibiotic prophylaxis has been shown to reduce the incidence of wound infection 3.
• Proper wound care and dressing are essential to prevent wound infection.
• The use of graduated compression stockings has been proposed as a method to prevent deep vein thrombosis, but its effect on preventing wound infection is unclear 6.

Management of Post-Operative CABG Complications

The management of post-operative CABG complications, including wound infection, requires a multidisciplinary approach.

• Emergency physicians play a crucial role in evaluating and managing post-operative CABG complications, including wound infection 7.
• Consultation with the primary surgical team is essential to optimize patient outcomes 7.