Task Force 4: Inpatient Management of Patients with MCSD - The ...

MCSD surgery is advised. 19 Preoperative skin cleansing with chlorhexidine-alcohol is
superior to povidone-iodine in clean-contaminated operations for prevention of
superficial and deep wound infections. 20
During surgical creation of the pocket (if needed) and placement of a MCSD,
organisms may be inoculated and later cause infection. Therefore, it is crucial to follow
meticulous antiseptic techniques in the operating room. HEPA filters and laminar air
flow in the operating room is suggested to maximize sterile ventilation. 21 Movement of
personnel should be restricted, and people present in the operating room should use
double gloving and headgear to completely cover their hair. 21 Antibiotic-soaked pads
should cover the pump and cannulas, and the pump should be extracted from its sterile
packing shortly before its placement in the pocket, 21 in order to minimize potential
contamination. Adequate hemostasis is important since hematomas may serve as
culture media for bacteria. Irrigation of the mediastinum with antibiotic solutions
(vancomycin and gentamicin) is performed before wound closure. 21
Post-Operative Routine Prophylaxis. Antibiotic prophylaxis beyond 48 hours
after surgery is generally unnecessary. 22 Some centers continue prophylaxis until chest
tubes are removed, or in the setting of delayed chest closure. Prolonged use of
vancomycin in high-risk general cardiac surgery patients was not beneficial in reducing
infection. 23 Also, in a retrospective study, decreasing the duration of vancomycin
prophylaxis by more than half was not associated with an increase in infection rate after
MCSD placement. 24 The use of nasal mupirocin to reduce MRSA colonization and
secondarily reduce staphylococcus infection is practiced by many centers. 25,26 The
optimal regimen for antibiotic prophylaxis in patients undergoing MCSD placement is
not known, but many centers use a combination of intravenous vancomycin, rifampin,
levofloxacin, and fluconazole as recommended in the REMATCH trial. 27,28 An important
consideration to take into account is the antibiotic resistance-profile of organisms in the
medical center performing the MCSD implant .
Secondary prophylaxis given for procedures (dental, respiratory, genitourinary,
gastrointestinal) have not been studied in MCSD recipients. In general, prophylaxis has
not been recommended for cardiac patients except in certain high risk groups such as
those with prosthetic valves, forms of congenital heart disease, and with valvulopathy
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