NHLBI Working Group
Antimicrobial Strategies and Cardiothoracic Surgery

Executive Summary

The National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID) convened a Working Group of investigators on April 4-5, 2002, in Bethesda, Maryland. This Working Group brought together experts to explore both basic science and clinical application research opportunities of antimicrobial strategies in the prevention and treatment of major infections following cardiac surgery.

The following recommendations were made to NHLBI and NIAID:

1. Utilize and expand databases such as the VAH, STS, Duke, and CCF to prospectively study the incidence and type of infection in a large group of patients undergoing heart surgery.
2. Support basic science research projects into virulence mechanisms and infectivity of S. aureus and other pathogens in cardiovascular surgical situations and device use.
3. Foster liaisons with industry and provide incentives for novel product development and clinical evaluation in cardiovascular clinical trials.
4. Collaborate with other Agencies to support multi-center, multidisciplinary medical/surgical staff teams of hospital-based “Cardiac Surgical Intervention Teams” to address optimal strategies for reducing the risk of cardiac surgical-related infections. Topics include control of nasal staphylococcal colonization, optimizing preoperative surgical preparatory interventions, and rigorous approaches to antibiotic or antibody prophylaxis strategies before and during surgery.
5. Conduct randomized clinical trials to evaluate prevention vs. therapy of S. aureus infections in patients undergoing cardiovascular procedures. In particular, design a clinical trial to study the efficacy of S. aureus conjugate vaccine in patients scheduled for cardiac surgery. These trials have different issues with regard to design and implementation, and decisions about which approaches will be most fruitful will require extensive deliberation and planning.

Working Group Members

• Franklin D. Lowy, M.D., Columbia University, New York, NY (Co-chair)
• John A. Waldhausen, M.D., the Pennsylvania State University College of Medicine Hershey, PA (Co-chair)
• Arnold Bayer, M.D., Harbor UCLA Medical Institute, Torrence, CA
• Robert Califf, M.D., Duke University Medical Center, Durham, NC
• George Eliopoulos, M.D., Beth Israel Deaconess Medical Center, Boston, MA
• Ali Fattom, Ph.D., NABI, Rockville, MD
• Vance Fowler, M.D., Duke University Medical School; Durham, NC
• Marc Gillinov, M.D., the Cleveland Clinic Foundation, Cleveland, OH
• Frederick Grover, M.D., University of Colorado, Denver, CO
• Magnus Hook, Ph.D., Matrix Biology, Houston, TX
• J. Glen Morris, M.D., MPH, TM, University of Maryland, Baltimore, MD
• Joseph Patti, Ph.D., Inhibitex, Alpharetta, GA
• Timothy Pruett, M.D., University of Virginia, Charlottesville, VA
• John Robbins, M.D., National Institute of Child Health and Development, Bethesda, MD
• Martin Rosenberg, Ph.D., Promega Corporation, Madison, WI
• Rachel Schneerson, M.D., National Institute of Child Health and Development Bethesda, MD