Surgical prophylaxis for thoracic surgery
Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis). See Thoracic surgery procedures and their requirement for surgical antibiotic prophylaxis for the recommendations for surgical prophylaxis for thoracic surgery.
For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.
|
Procedures |
Is surgical antibiotic prophylaxis indicated? |
|---|---|
|
intercostal catheter insertion brachiocephalic procedures (eg carotid endarterectomy, brachial artery repair) not involving insertion of prosthetic material |
NO |
|
procedures involving insertion of prosthetic material thoracic surgery procedures associated with an increased risk of infection, including video-assisted thoracoscopic surgery (VATS), aneurysm repair, thromboendarterectomy and vein bypass |
YES |
If prophylaxis is indicated for thoracic surgery, use:
cefazolin 2 g (child: 30 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, thoracic cefazolin
For patients colonised or infected with methicillin-resistant Staphylococcus aureus (MRSA), or at increased risk of being colonised or infected with MRSA (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), add to cefazolin:
vancomycin (adult and child) 15 mg/kg up to 2 g intravenously, started within the 120 minutes before surgical incision (recommended rate 10 mg/minute)1; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, thoracic vancomycin
For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, use cefazolin, with or without vancomycin, as above. See also Surgical antibiotic prophylaxis for patients with a penicillin or cephalosporin allergy.
For patients with immediate severe or delayed severe hypersensitivity to penicillins, use vancomycin as monotherapy (see dosage above).
For thoracic surgery, a single preoperative dose of surgical antibiotic prophylaxis is sufficient to prevent postoperative infection. Postoperative (intravenous or oral) antibiotics do not provide benefit and increase the risk of subsequent infections with resistant pathogens and Clostridioides difficile.