title: Prophylactic intracavitary (pneumonectomy space) antibiotic instillation: a comparative study.
abstract: OBJECTIVE
  Postpneumonectomy empyema is a dreaded complication of pneumonectomy. The effectiveness of prophylactic intracavitary antibiotic instillation is not known. We conducted a retrospective review to assess the effect of pneumonectomy space antibiotic instillation on septic complications (empyema and bronchial fistula) of pneumonectomy.
  
  
  METHODS
  Ninety-three consecutive patients underwent pneumonectomy at our institution over a three-year period. Their charts were reviewed retrospectively and data was collected on age, gender, diagnosis, intravenous antibiotics, intracavitary (pneumonectomy space) antibiotics, empyemas, bronchial fistulas, length of hospital stay, and operative mortality.
  
  
  RESULTS
  All 93 patients received 3 perioperative doses of prophylactic intravenous antibiotics. One group (n=47) of patients also received intraoperative intracavitary instillation of an antibiotic solution (penicillin G: 5 million units, bacitracin: 50,000 units, gentamicin: 60 mg, in 1 litre of saline) while the other group (n=46) did not. Age, gender, diagnosis, and length of stay were not significantly different in the two groups. There were no empyemas or bronchial fistulas in the intracavitary antibiotic group. Postpneumonectomy empyemas occurred in 6 (13%) patients (empyema with bronchial fistula: 5, empyema alone: 1) that had not received intracavitary antibiotics (p=0.012). There were 4 deaths (9%) in each group (p=0.63).
  
  
  CONCLUSIONS
  Prophylactic intraoperative intracavitary antibiotic instillation may reduce the incidence of empyemas after pneumonectomy. However, a randomized trial would be needed to prove the effectiveness of this form of prophylactic antibiotic strategy.
authors.affiliation: Department of Surgery, McMaster University, Canada.
authors.forename: J D
authors.initials: JD
authors.lastname: Miller
authors.forename: J
authors.initials: J
authors.lastname: Nemni
authors.forename: C
authors.initials: C
authors.lastname: Simone
authors.forename: J E
authors.initials: JE
authors.lastname: Young
authors.forename: W F
authors.initials: WF
authors.lastname: Bennett
authors.forename: J D
authors.initials: JD
authors.lastname: Urschel
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis; D001414:Bacitracin / Q000008:administration & dosage* / Q000627:therapeutic use*; D001983:Bronchial Fistula / Q000517:prevention & control*; D016724:Empyema, Pleural / Q000517:prevention & control*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D007322:Instillation, Drug; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000008:administration & dosage* / Q000627:therapeutic use*; D011013:Pneumonectomy; D012189:Retrospective Studies
chemical_list: D005839:Gentamicins; D001414:Bacitracin; D010400:Penicillin G