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SURGICAL ANTIBIOTIC PROPHYLAXIS GUIDELINES WITHIN CARDIAC SUGERY FOR
ADULT PATIENTS
Contact Name and Job Title (author)

Dr Tim Boswell, Consultant Microbiologist
Annette Clarkson, Specialist Clinical Pharmacist
Antimicrobials and Infection Control

Directorate & Speciality

Diabetes, Infection, Renal and Cardiovascular
directorate (Cardiac surgery)

Date of submission

June 2013

Date on which guideline must be reviewed (this should be one
to three years)
Explicit definition of patient group to which it applies (e
...

inclusion and exclusion criteria, diagnosis)

June 2015

Changes from previous guideline

Clarification on vancomycin administration
duration
...
Change to the cefuroxime
dosing for penicillin allergic patients
...
The
guideline also provides recommendations for
the antibiotic treatment of post-op surgical site
infection
Cardiac, surgery, antibiotic, prophylaxis

Abstract

Key Words

Statement of the evidence base of the guideline – has the
guideline been peer reviewed by colleagues?
Evidence base: (1-5)
1a
meta analysis of randomised controlled trials
1b
at least one randomised controlled trial
2a
at least one well-designed controlled study without
randomisation
2b
at least one other type of well-designed quasiexperimental study
3
well –designed non-experimental descriptive studies
(ie comparative / correlation and case studies)
4
expert committee reports or opinions and / or clinical
experiences of respected authorities
5
recommended best practise based on the clinical
experience of the guideline developer
Consultation Process

Target audience

All adult patients undergoing cardiac surgery

Evidence levels: Range from 1a and then 3-5
SIGN guideline 104 - Antibiotic prophylaxis in
surgery
...
Oct 2008
Also incorporates local microbiological
surveillance data

NUH Antimicrobial Guidelines Committee
NUH Drugs and Therapeutics Committee
Prescribers, nursing staff and pharmacists
caring for patients undergoing cardiac surgery

This guideline has been registered with the trust
...
The
interpretation and application of clinical guidelines will remain the responsibility of the individual clinician
...
Caution is advised when using guidelines after the review
date
...
Introduction

3

2
...
1 Timing for Administration
2
...
3 Post-operative antibiotic prophylaxis
3
...
aureus eradication treatment - ALL patients

4

4
...
Empirical treatment of surgical site infection

Dr Tim Boswell, Annette Clarkson

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5

Review June 2015

Dr Tim Boswell, Annette Clarkson

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Clostridium difficile

•
•
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1
...
aureus eradication treatment – ALL patients
Mupirocin 2% (Bactroban®) nasal ointment (topically to each nostril) TDS for 5 days starting 1
day pre-op PLUS Octenisan® washes OD for 5 days and wash hair twice in the five days
starting 1 day pre-op

4) Routine cardiac surgical antibiotic prophylaxis
Valve surgery
IV Vancomycin 1g (over at least 100mins to prevent red man syndrome) aiming for infusion to
be complete by time of induction then a second dose of vancomycin 1g 12 hours later
...
e
...
5g at induction (plus a
further 750mg when off bypass) then a further 2 doses of 1
...

If history of severe allergy to penicillins then discuss with Medical Microbiologist
...
5g tds (not in penicillin allergy) plus IV Vancomycin, refer to
vancomycin dosing guideline or use vancomycin dosing calculator on the antibiotic website
...
If patient has previously isolated a multi resistant gram
negative and does not have a severe penicillin allergy (i
...
no angioedema / anaphylaxis
or immediate onset urticarial rash):
IV Meropenem 1g tds plus IV Vancomycin, refer to vancomycin dosing guideline or use
vancomycin dosing calculator on the antibiotic website
...


Dr Tim Boswell, Annette Clarkson

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