Should we change antibiotic prophylaxis for lung surgery? Postoperative pneumonia is the critical issue.
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.
Schussler
Olivier
O
Department of Thoracic Surgery, Hotel-Dieu Hospital, APHP, Paris V University, Paris, France.
Dermine
Herve
H
Alifano
Marco
M
Casetta
Anne
A
Coignard
Sophie
S
Roche
Nicolas
N
Strano
Salvatore
S
Meunier
Alain
A
Salvi
Maurizio
M
Magdeleinat
Pierre
P
Rabbat
Antoine
A
Regnard
Jean François
JF
D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000379:methods* / Q000706:statistics & numerical data; D001991:Bronchitis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D016022:Case-Control Studies; D002435:Cefamandole / Q000008:administration & dosage; D002511:Cephalosporins / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology; D015996:Survival Rate
D002511:Cephalosporins; D002435:Cefamandole; D019980:Amoxicillin-Potassium Clavulanate Combination