Abstract: Poster Presentations |

Antibiotic Choices for Pulmonary Resections-Gram-Negative Prophylaxis Decreases Pulmonary Complications but Increases Wound Infections FREE TO VIEW

John R. Roberts, MD, MBA*
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The Surgical Clinic: Centennial Medical Center; Baptist Hospital, Nashville, TN


Chest. 2004;126(4_MeetingAbstracts):860S. doi:10.1378/chest.126.4_MeetingAbstracts.860S
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PURPOSE:  Prophylaxis for pulmonary surgery has, almost by default, been those antibiotics typically used for cardiac surgery, which cover primarily gram-positive organisms. We report a study in which we performed a historical comparison of the complications between two groups of patients-those receiving preoperative gram-positive coverage and those receiving preoperative gram-negative coverage.

METHODS:  All patients undergoing lung resection were eligible for comparison. Data collected were age, stage of tumor, incidence of atelectasis or mucous plugging requiring bronchoscopy, wound infection, life-threatening complications, and death. Patients undergoing surgery between September 1997 and November 2000 received cefazolin and those undergoing surgery between December 1, 2000 and August 2003 received cefipime. Cefipime was chosen because it covers the most common Pseudomonas grown in our hospitals. Means were compared using student’s t test and proportions with chi-square. p less than 0.05 was accepted as significant.

RESULTS:  Four hundred sixty-seven patients underwent lung resection in the five year period. Two hundred twenty-three received cefazolin while two hundred forty received cefipime. No differences in age, reintubation rate, life-threatening complications, nor mortality rate were found. Significant differences in the incidence of pulmonary complications (measured by the need for urgent bronchoscopies) were found that favored cefipime. However, seven patients receiving cefipime developed chest wall infections with MRSA. Only one such minor infection was found in patients receiving cefazolin. These differences were highly significant.

CONCLUSION:  Gram-negative prophylaxis in pulmonary resections decreases the incidence of pulmonary complications in patients undergoing lung resection. However, those patients with chest wall resections are prone to develop methicillin resistant mesh infections, and should be covered with gram-positive coverage.

CLINICAL IMPLICATIONS:  Preoperative gram-negative antibiotic coverage decreases perioperative pulmonary complications in patients undergoing lung resection. AGE (years)Broncho-Reintuba-Wound InfectionsMortalityGram-Positive Antibiotics62.5 ± 13.215.6%5.83%0.5%2.2%Gram-Negative Antibiotics58.8 ± 14.54.7%4.8%7.8%3.3%p-Value0.1280.02200.8640.00002540.456

DISCLOSURE:  J.R. Roberts, None.

Wednesday, October 27, 2004

12:30 PM- 2:00 PM




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