CONTROLLED TRIAL OF PROPHYLACTIC PENICILLIN IN THORACIC SURGERY

[Antibiotic prophylaxis in thoracic surgery, pulmonary endoscopy, thoracic injuries and lung transplantation]

Effectiveness of prophylactic antibiotics is at present time well documented for many surgical procedures. In lung surgery, numerous randomized double-blinded studies have demonstrated the effectiveness of 1st or 2nd generation cephalosporins, administered over a short period of time, not exceeding 24 h. In the opposite, thoracic injuries do not seem to require prophylactic antibiotics, except penetrating injuries of the chest, which could benefit from a single antibiotic injection. In case of lung transplantation, infectious complications result from many factors, among which immunosuppression plays an important role. A prolonged antibiotherapy is routinely used by many transplantation teams, despite the lack of studies proving the effectiveness of this practice.

Antibiotic prophylaxis in pulmonary surgery: a double-blind study of penicillin versus placebo

A prospective, randomized double-blind study comparing high-dose short-term penicillin-G prophylaxis with placebo was conducted on patients referred for elective pulmonary surgery. The major advantages of penicillin prophylaxis over placebo were observed for wound infections (2/45 vs 9/47, respectively, p = 0.03), postoperative antibiotic use (13/45 vs 23/47, respectively, p = 0.049), and postoperative hospital stay (median 10 days vs 13 days, respectively, p = 0.02). The prophylactic penicillin regimen had no effect on the incidence of empyema or lower respiratory tract infections. Staphylococcus aureus and Haemophilus were identified as the major pathogens in post-operative infections. Penicillin significantly reduced the incidence of S. aureus in spite of resistance to penicillin in most isolated strains, while the frequency of Haemophilus was similar in the two treatment groups. Colonization with Enterobacteriaceae and Pseudomonas aeruginosa was pronounced in the penicillin group. Few side-effects of penicillin treatment were recorded. Short-term penicillin prophylaxis is recommended, but the ideal prophylactic regimen in pulmonary surgery has not yet been found.

The incidence of postoperative infection and the role of antibiotic prophylaxis in pulmonary surgery. A review of 221 consecutive patients undergoing thoracotomy

A study was made of the organisms cultured from the respiratory tract at or before operation and of the incidence of postoperative bronchopleural fistula, pneumonectomy space infection or chest infection in 221 consecutive patients undergoing thoracotomy. Patients receive either no antibiotics or one of three variations of an ampicillin/flucloxacillin mixture. Prophylactic systemic antibiotics significantly reduced the number of pneumonectomy space and chest infections; application of penicillin plus streptomycin powder to the bronchial stump had no effect. Systemic antibiotics given preoperatively reduced the incidence of bronchopleural fistula. The type of bacteria present in the preoperative sputum or bronchial lumen at operation was no help in predicting the effect therapy of postoperative infection.