Postoperative pneumonia after major pulmonary resections: an unsolved problem in thoracic surgery.
BACKGROUND
Antibiotics currently recommended for prophylaxis in thoracic surgery are first-generation and second-generation cephalosporins. Despite this prophylaxis, postoperative pneumonia after major pulmonary resections remains frequent and severe. However, in the medical literature, the origin of these infections is poorly documented.


METHODS
To evaluate the efficiency of current prophylactic regimens, we retrospectively analyzed 312 consecutive cases of major pulmonary resection, performed between January 2000 and December 2004. For patients who experienced postoperative pulmonary infection, the microbiologic agents and their antibiotic susceptibility were studied.


RESULTS
A postoperative pneumonia was diagnosed in 76 patients (24.4% +/- 0.43%). Sixty patients (78.9%) experienced the infection in the first 5 postoperative days. A microbiologic documentation was obtained in 44 cases (57.9%) with 56 microorganisms involved. Pathogens responsible for the infections were Staphylococcus aureus (n = 10), Streptococcus pneumoniae (n = 8), group B Streptococcus organisms (n = 1), nongroupable Streptococcus organisms (n = 2), Enterococcus faecalis (n = 1), Haemophilus spp. (n = 9), Branhamella catarrhalis (n = 2), Enterobacteriaceae (n = 15), Pseudomonas aeruginosa (n = 3), Acinetobacter baumannii (n = 1), and Candida spp. (n = 4). According to the antibiotic susceptibility testings, the prophylactic regimen by cefazolin proved ineffective for 84% of the microbiologically documented cases.


CONCLUSIONS
This study confirmed the inefficiency of current prophylaxis against pathogens involved in postoperative pneumonia after major lung resections. Evaluation of new and more-adapted approaches of antibiotic prophylaxis should be the subject of prospective multicenter trials.
Radu
Dana M
DM
Department of Thoracic and Vascular Surgery, Avicenne Hospital, Bobigny, France. danabudescu@gmail.com
Jauréguy
Françoise
F
Seguin
Agathe
A
Foulon
Clément
C
Destable
Marie Dominique
MD
Azorin
Jacques
J
Martinod
Emmanuel
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D004755:Enterobacteriaceae / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D018410:Pneumonia, Bacterial / Q000209:etiology* / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control
D002511:Cephalosporins; D002437:Cefazolin