ABSTRACT

Background. The recommended antibiotic prophylaxis by second generation cephalosporin reduces the incidence of wound infection an empyema, but its effectiveness on postoperative pneumonias after major lung resection lacks demonstration. Patients and methods. A prospective study in 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 84 (47.72%) patients in the first period and 92 (52.28) patients in the second period. The incidence of postoperative pneumonias decreased by 50% during the second period (p = 0-0027). Thirty-day mortality decreased from 3.5 to 1.5% (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 postoperative pneumonia. Conclusions. Targeted antibiotic prophylaxis may decrease the rate of postoperative pneumonia after lung resection and improve outcome.

KEYWORDS

Antibiotic prophylaxis, lung surgery, postoperative pneumonia, major lung resection.

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