Preoperative microbiologic screening and antibiotic prophylaxis in pulmonary resection operations

Area of Science:

• Thoracic Surgery
• Infectious Disease Prevention
• Pharmacology

Background:

• Pulmonary resection carries a significant risk of postoperative infection, making antibiotic prophylaxis a standard practice.
• This study evaluated two common antibiotic prophylaxis regimens against preoperatively identified microorganisms.

Purpose of the Study:

• To compare the efficacy of sulbactam plus ampicillin versus cefazolin for antibiotic prophylaxis in patients undergoing pulmonary resection.
• To assess the impact of preoperative microbial analysis on antibiotic prophylaxis effectiveness.

Main Methods:

• A prospective randomized trial involving 120 patients undergoing elective pulmonary resection.
• Patients received either sulbactam/ampicillin (n=60) or cefazolin (n=60) as single-shot prophylaxis.
• Intraoperative lung aspirates were cultured, and antibiotic susceptibility was tested; patients were monitored for 3 days post-surgery for infections.

Main Results:

• Fifty-eight pathogens were isolated; bacterial profiles were similar between groups.
• All isolates were susceptible to sulbactam/ampicillin, while 8/25 in the cefazolin group showed resistance.
• The cefazolin group experienced significantly more bronchopulmonary infections, required more additional antibiotics, and had longer ICU stays and higher costs.

Conclusions:

• Preoperative microbial assessment aids in selecting effective antibiotic prophylaxis.
• Sulbactam plus ampicillin proved significantly more effective than cefazolin in preventing infections after pulmonary resection.