Table 3.

Antibiotic therapy options for surgical site infection in cardiac surgery.

Empiric Antibiotic Therapy
Vancomycin * 15–20 mg/kg based on actual body weight q8–12 h i.v. or daptomycin 8–10 mg/kg/d i.v. + piperacillin/tazobactam 4.5 g q6h i.v. or meropenem 1 g q8h i.v.
Targeted Antibiotic Therapy
Aetiology	First-Line Treatment	Alternative Treatment
Staphylococcus aureus MSSA	-cloxacillin 2 g q6h i.v.	-cefazolin 2 g q8h i.v. -in the case of non-immediate reaction: -cefazolin 2 g q8h i.v. in the case of immediate reaction: -vancomycin * 15–20 mg/kg based on actual body weight q8–12h i.v.
Staphylococcus aureus MRSA	-vancomycin * 15–20 mg/kg based on actual body weight q8–12h i.v. or -daptomycin 8–10 mg/kg/d i.v.	-teicoplanin: three loading doses of 400 mg i.v. administered q12h followed by 400 mg/d i.v. -ceftaroline 600 mg q12h i.v.
Streptococcus spp.	-benzylpenicillin 5–6 MIU q6h i.v.	-ampicillin 2 g q4–6h i.v. -ceftriaxone 2 g q24h i.v. in the case of immediate reaction: -vancomycin * 15–20 mg/kg based on actual body weight q8–12h i.v.
Enterococcus faecalis ***	HLAR (−) strains -ampicillin 2 g q4–6h i.v. + Gentamicin ** 3 mg/kg q24h i.v. HLAR (+) strains -ampicillin 2 g q4–6h i.v. + ceftriaxone 2 g q12h i.v.	HLAR (−) strains in case of immediate reaction: Vancomycin * 15–20 mg/kg based on actual body weight q8–12h i.v. + Gentamicin ** 3 mg/kg q24h i.v. HLAR (+) strains in case of immediate reaction—consultation with antibiotic therapy expert indicated
Enterococcus faecium	HLAR (−) strains: vancomycin * 15–20 mg/kg based on actual body weight q8–12h i.v. + gentamicin ** 3 mg/kg q24h i.v. HLAR (+) strains: consultation with antibiotic therapy expert indicated
Enterobacterales bacilli	-ceftriaxone 2 g q24h, i.v. -ciprofloxacin 400 mg q8h i.v.	ESBL (+) strains: -meropenem 1 g q8h i.v. -imipenem/cilastatin 500 mg/500 mg q6h i.v.
Pseudomonas aeruginosa	-ceftazidime 2 g q8h i.v. -piperacillin/tazobactam 4.5 g q6h i.v.	-cefepime 2 g q8h i.v. -meropenem 1 g q8h i.v. -imipenem/cilastatin 500 mg/500 mg q6h i.v.
Acinetobacter baumannii	according to antibiogram, antibiotic susceptibility—difficult to predict, but usually susceptibility to: -meropenem 1 g q8h i.v. -imipenem/cilastatin 500 mg/500 mg q6h i.v. -ampicillin/sulbactam 3 g q4–6h i.v.	-colistin loading dose 9 million IU i.v. followed by 4.5 million IU q12h i.v. (at MIC = 2, increase the dose up to 12 million IU/d)
Gram(−) bacilli resistant to carbapenems	antibiotic susceptibility difficult to predict—consultation with an infectious disease specialist indicated
Candida spp.	initial therapy: -liposomal amphotericin B, 3–5 mg/kg/d with or without flucytosine or -echinocandin (caspofungin 150 mg/d or anidulafungin 200 mg/d or micafungin 150 mg/d) Echinocandin may be switched to fluconazole (400–800 mg/d) in clinically stable patients with fluconazole-susceptible Candida spp. isolates and with negative follow-up blood culture results.

* subsequent vancomycin doses based on concentration monitoring using AUC/MIC; ** it is necessary to monitor minimum and maximum gentamicin concentrations; *** therapy combined with gentamicin applies to patients with mediastinitis. MSSA—methicillin-susceptible Staphylococcus aureus; MRSA—methicillin-resistant Staphylococcus aureus; HLAR—high-level aminoglycoside resistant.