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Perioperative Antiinfektivaprophylaxe in der Kardiochirurgie

Perioperative anti-infective prophylaxis in cardiac surgery

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Hintergrund

Die Antibiotikaprophylaxe kann entscheidend zum Erfolg kardiochirurgischer Eingriffe beitragen. Für ihren Erfolg sind die richtige Wahl, Dauer, Zeitpunkt und Dosis der Antibiotikaapplikation entscheidend. Dieser Beitrag gibt einen Überblick über die gängige Praxis der antiinfektiven Prophylaxe.

Material und Methoden

Es wurde eine selektive Literaturrecherche in Pubmed durchgeführt.

Ergebnisse

Cephalosporine der ersten und zweiten Generation sind die meistverwendeten Wirkstoffe der Antibiotikaprophylaxe in der Kardiochirurgie. Ihr Wirkspektrum eignet sich gut zur Prophylaxe der infrage kommenden Erreger. Vancomycin kann eine Rolle bei MRSA-positiven Patienten sowie in Kliniken mit Hochprävalenz spielen. Die Dauer sollte 24 h nicht übersteigen. Der optimale Zeitpunkt liegt in der letzten Stunde vor dem ersten Schnitt. Eine höhere Dosis als die Standarddosis der verabreichten Antibiotika erbringt keinen Vorteil.

Diskussion

Die meisten Daten existieren zur Verwendung der Cephalosporine, sie sind für diese Indikation gut geeignet. Eine deutsche Leitlinie für die antibiotische Prophylaxe in der Kardiochirurgie fehlt bislang.

Abstract

Background

Antibiotic prophylaxis in cardiac surgery can improve the outcome of cardiothoracic procedures. Therefore, selection of the correct antimicrobial agent, the duration of administration, the time point of administration, and the correct dose have an influence on the success of cardiac surgery. This article gives an overview of daily practices and options pertaining to antibiotic prophylaxis in cardiac surgery.

Materials and methods

A selective literature review was carried out in PubMed.

Results

First- and second-generation cephalosporins are the most frequently administered antibiotics for prophylaxis in cardiac surgery. Most of the pathogens causing surgical site infections are addressed by this group. Vancomycin is a good choice for MRSA-positive patients, or in clinics with a high MRSA prevalence. Duration should not exceed 24 hours. The best time point for administration is during the last hour prior to the first incision. A higher dose than is standard for the particular antibiotic is not beneficial.

Conclusion

Most data exist for first- and second-generation cephalosporins, which are well suited for this indication. To date, there are no German guidelines for antibiotic prophylaxis in cardiac surgery.

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Authors and Affiliations

  1. Medizinische Klinik II, Schwerpunkt Infektiologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    N. Wetzstein &  H.-R. Brodt

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Correspondence to N. Wetzstein.

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N. Wetzstein und H.-R. Brodt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Wetzstein, N., Brodt, HR. Perioperative Antiinfektivaprophylaxe in der Kardiochirurgie. Z Herz- Thorax- Gefäßchir 30, 120–126 (2016). https://doi.org/10.1007/s00398-015-0056-z

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