| Title | Should we change antibiotic prophylaxis for lung surgery? Postoperative pneumonia is the critical issue. | | Author(s) | Schussler O, Dermine H, Alifano M, Casetta A, Coignard S, Roche N, Strano S, Meunier A, Salvi M, Magdeleinat P, Rabbat A, Regnard JF | | Institution | Department of Thoracic Surgery, Hotel-Dieu Hospital, APHP, Paris V University, Paris, France. | | Source | Ann Thorac Surg 2008 Dec; 86(6):1727-33. | | MeSH | Aged
Amoxicillin-Potassium Clavulanate Combination
Antibiotic Prophylaxis
Bronchitis
Case-Control Studies
Cefamandole
Cephalosporins
Dose-Response Relationship, Drug
Drug Administration Schedule
Education, Medical, Continuing
Female
Follow-Up Studies
France
Humans
Incidence
Lung Diseases
Male
Middle Aged
Multivariate Analysis
Pneumonectomy
Pneumonia, Bacterial
Postoperative Complications
Preoperative Care
Probability
Prospective Studies
Reference Values
Risk Assessment
Surgical Wound Infection
Survival Rate
| | Abstract | BACKGROUND: The recommended antibiotic prophylaxis by second-generation cephalosporins reduces the incidence of wound infection and empyema, but its effectiveness on postoperative pneumonias (POPs) after major lung resection lacks demonstration. We investigated risk factors and characteristics of POPs occurring when antibiotic prophylaxis by second-generation cephalosporin or an alternative prophylaxis targeting organisms responsible for bronchial colonization was used.
METHODS: An 18-month prospective study on all patients undergoing lung resections for noninfectious disease was performed. Prophylaxis by cefamandole (3 g/24 h, over 48 hours) was used during the first 6 months, whereas amoxicillin-clavulanate (6 g/24 h, over 24 hours) was used during the subsequent 12 months. Intraoperative bronchial aspirates were systematically cultured. Patients with suspicion of pneumonia underwent bronchoscopic sampling for culture.
RESULTS: Included were 168 patients in the first period and 277 patients in the second period. The incidence of POP decreased by 45% during the second period (P = 0.0027). A significant reduction in antibiotic therapy requirement for postoperative infections (P = 0.0044) was also observed. Thirty-day mortality decreased from 6.5% to 2.9% (P = 0.06). Multivariate analysis showed that type of resection, intraoperative colonization, chronic obstructive pulmonary disease, gender, body mass index, and type of prophylaxis were independent risk factors of POP. A case control-study that matched patients of the two periods according to these risk factors (except for antibiotic prophylaxis) confirmed that the incidence of POP was lowered during the second period.
CONCLUSIONS: Targeted antibiotic prophylaxis may decrease the rate of POPs after lung resection and improve outcome. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 19021965 |
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