الفهرس | Only 14 pages are availabe for public view |
Abstract Cardiovascular surgery is a surgery on the heart or great vessels done to treat complications of ischemic heart disease (for example, coronary artery bypass grafting), correct congenital heart disease, or treat valvular heart disease from various causes including endocarditis, rheumatic heart disease and atherosclerosis. Prophylactic intravenous antibiotics should be routinely administered to patients undergoing cardiac surgery and the use of antimicrobials for cardiovascular surgical infection prophylaxis is considered the standard of care, with the goal of preventing surgical site infections such as wound infection, mediastinitis, and endocarditis. There is general consensus that postoperative prophylactic antibiotics should be stopped within 24 hours of most major surgical procedures. However, results of studies on the general surgical population do not directly apply to cardiac surgery. The most obvious reason is the fact that cardiopulmonary bypass is used in cardiac surgery. Cardiopulmonary bypass used in cardiac surgery is a nonphysiological assisting device, the pump itself is associated with a broad array of adverse physiologic sequelae that predispose cardiac surgery patients to infectious complications. Cardiopulmonary bypass is known to compromise humoral immunologic defenses, reduce phagocytosis, and activate white blood cells, all of which impair the ability to neutralize infectious organisms. The often-used systemic hypothermia is associated with increased surgical site infection and it has profound effects on the volume of distribution, and elimination kinetics of a variety of drugs including the commonly used prophylactic antibiotics such as cephalosporin, vancomycin and aminoglycosides. The length of a surgical procedure is also generally correlated with the risk of postoperative infection. Cardiac surgical procedures routinely require 3 to 4 hours for completion, thereby placing patients at increased infectious risk. In addition, cardiac surgery patients invariably leave the operating room with indwelling chest catheters that have the potential to serve as external routes for bacterial entry. |