For infections related to implantable electrophysiologic devices, complete device removal and antimicrobial therapy allow timely, successful reimplantation at a remote anatomic site without substantial risk for operative mortality or recurrent infection.

No abstract

PREAMBLEOur mission was to develop evidence-based American Association for Thoracic Surgery (AATS) consensus focused on the surgical treatment of infective endocarditis (IE) and perioperative questions: when to operate, how to prepare the patient for operation, how to operate, and other issues relevant to managing and following patients after surgery. [1][2][3][4][5][6][7][8] The writing committee included 4 cardiac surgeons, 1 cardiologist, 2 infectious disease specialists, and Dr Eugene H. Blackstone. The draft produced was reviewed by invited additional experts, including 4 cardiac surgeons, 1 anesthesiologist, 1 cardiologist, 2 imaging experts, 3 infectious disease specialists, and 1 neurologist (See Appendix E1).

In conclusion, posttransplantation histoplasmosis is rare (1 case per 1000 transplant-person-years; 95% confidence interval, 0.6-1.7), even in endemic areas. Prognosis is good but requires protracted therapy. Patients with latent infection did not develop posttransplantation histoplasmosis when prophylaxis was used.

Although the incidence of sternal wound infections has decreased to 1% to 4% of all cardiac surgery procedures, they continue to be associated with increased morbidity and mortality, and decreased long-term life expectancy. [1][2][3] They prolong hospital length of stay and can raise hospital costs by as much as US$62,000. 4 Sternal wound infections are now publicly reported, and the US Center for Medicare and Medicaid services will no longer reimburse hospital costs incurred in the treatment of deep sternal wound infections (DSWI) following coronary artery bypass graft (CABG) surgery. 5 Despite the significant clinical and economic consequences of sternal wound infections, there are currently no specific guidelines in cardiac surgery for the prevention and treatment of sternal wound infections. What follows are recommendations for the prevention of wound infections during the preoperative, intraoperative, and postoperative periods, as well as principles for the most effective methods and techniques to treat sternal wound infections to achieve the lowest morbidity and mortality as derived from evidence-based recommendations (Tables 1 and 2). METHODSA literature search was performed using PubMed and Google Scholar up to March 2015 using the MeSH headings ''Sternal Wound Infections -Prevention and Treatment,'' ''Treatment of Mediastinitis,'' ''Topical Antibiotics in Cardiac Surgery,'' ''Wound VAC Therapy for Sternal Wound Infections,'' and ''Prevention and Treatment of Sternal Instability.'' Editorials and articles involving prevention and therapy for wound infections in noncardiac, nonsternotomy patients were excluded.The systemic review was reported according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines 6 (Figure 1).