Post-operative sternotomy/mediastinitis
- Sternal debridement and bone cultures recommended. Tailor antibiotics to C&S results.
- If S. aureus confirmed, and sternal wires cannot be removed, consider follow-up prolonged (months) oral therapy with (ciprofloxacin or levofloxacin or doxycycline or TMP/SMX) + rifampin, or clindamycin alone.
- Tetanus prophylaxis recommended.
Usual Pathogens
S. aureus/MRSA
S. epidermidis
Rare:
Enterobacterales
Corynebacterium spp
Candida spp
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin | 15mg/kg IV q12h | 6-8 weeks |
| + | ||
| Ceftriaxone | 1-2g IV daily |