| Should we change antibiotic prophylaxis for lung surgery? Postoperative pneumonia is the critical issue. | |
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MedLine Citation:
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PMID: 19021965 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Olivier Schussler; Herve Dermine; Marco Alifano; Anne Casetta; Sophie Coignard; Nicolas Roche; Salvatore Strano; Alain Meunier; Maurizio Salvi; Pierre Magdeleinat; Antoine Rabbat; Jean François Regnard |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 86 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2008 Dec |
Date Detail:
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Created Date: 2008-11-21 Completed Date: 2009-01-06 Revised Date: 2009-08-24 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1727-33 Citation Subset: AIM; IM |
Affiliation:
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Department of Thoracic Surgery, Hotel-Dieu Hospital, APHP, Paris V University, Paris, France. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Amoxicillin-Potassium Clavulanate Combination / administration & dosage Antibiotic Prophylaxis / methods*, statistics & numerical data Bronchitis / epidemiology*, etiology, microbiology Case-Control Studies Cefamandole / administration & dosage Cephalosporins / administration & dosage* Dose-Response Relationship, Drug Drug Administration Schedule Education, Medical, Continuing Female Follow-Up Studies France Humans Incidence Lung Diseases / mortality, pathology, surgery* Male Middle Aged Multivariate Analysis Pneumonectomy / adverse effects*, methods Pneumonia, Bacterial / epidemiology*, etiology, microbiology Postoperative Complications / epidemiology, prevention & control Preoperative Care / methods Probability Prospective Studies Reference Values Risk Assessment Surgical Wound Infection / epidemiology, microbiology Survival Rate |
| Chemical | |
Reg. No./Substance:
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0/Cephalosporins; 34444-01-4/Cefamandole; 74469-00-4/Amoxicillin-Potassium Clavulanate Combination |
| Comments/Corrections | |
Comment In:
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Ann Thorac Surg. 2008 Dec;86(6):1733-4
[PMID:
19021966
]
Ann Thorac Surg. 2009 Aug;88(2):707 [PMID: 19632457 ] Ann Thorac Surg. 2009 Sep;88(3):1051; auhtor reply 2052 [PMID: 19699971 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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