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a Department of Thoracic and Vascular Surgery, Avicenne Hospital, Bobigny, and Assistance Publique des Hôpitaux de Paris, Paris XIII University, Paris, France
b Department of Microbiology and Hygiene, Avicenne Hospital, Bobigny, and Assistance Publique des Hôpitaux de Paris, Paris XIII University, Paris, France
Accepted for publication May 22, 2007.
* Address correspondence to Dr Radu, Laboratoire d’Etudes des Greffes et Prothèses Cardiaques, Hôpital Broussais, 96 rue Didot, Paris Cedex 14, 75014, France (Email: danabudescu{at}gmail.com).
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.
Related Article
Ann. Thorac. Surg. 2007 84: 1674.
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  A. Terzi, A. Campione, P. Scanagatta, and G. Rizzardi Postoperative pneumonia after major pulmonary resections: should we try alternative ways to antibiotic change? Ann. Thorac. Surg., August 1, 2009; 88(2): 707 - 707. [Full Text] [PDF]
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O. Schussler, H. Dermine, M. Alifano, A. Casetta, S. Coignard, N. Roche, S. Strano, A. Meunier, M. Salvi, P. Magdeleinat, et al. Should We Change Antibiotic Prophylaxis for Lung Surgery? Postoperative Pneumonia Is the Critical Issue Ann. Thorac. Surg., December 1, 2008; 86(6): 1727 - 1733. [Abstract] [Full Text] [PDF]
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D. M. Radu, F. Jaureguy, and E. Martinod Reply. Ann. Thorac. Surg., September 1, 2008; 86(3): 1060 - 1060. [Full Text] [PDF]
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A. Terzi, L. Luzzi, A. Campione, and A. Gorla Postoperative Pneumonia After Major Pulmonary Resections: The Importance of Gastrointestinal Tract Management Ann. Thorac. Surg., September 1, 2008; 86(3): 1059 - 1060. [Full Text] [PDF]
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 F. T. Lytle and D. R. Brown Appropriate Ventilatory Settings for Thoracic Surgery: Intraoperative and Postoperative Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2008; 12(2): 97 - 108. [Abstract] [PDF]
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D. Beggs Invited commentary Ann. Thorac. Surg., November 1, 2007; 84(5): 1674 - 1674. [Full Text] [PDF]
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