Prophylactic intracavitary (pneumonectomy space) antibiotic instillation: a comparative study

Area of Science:

• Thoracic Surgery
• Infectious Disease Prevention
• Surgical Oncology

Background:

• Postpneumonectomy empyema is a serious complication following lung removal surgery.
• The efficacy of prophylactic antibiotic instillation into the pneumonectomy space is currently unknown.
• This study aimed to evaluate the impact of antibiotic instillation on septic complications.

Purpose of the Study:

• To assess the effectiveness of prophylactic intracavitary antibiotic instillation in preventing empyema and bronchial fistula after pneumonectomy.
• To determine if antibiotic instillation in the pneumonectomy space reduces septic complications.

Main Methods:

• Retrospective review of 93 consecutive patients undergoing pneumonectomy over three years.
• Patients received standard intravenous antibiotics; one group (n=47) also received intraoperative intracavitary antibiotic solution, while the control group (n=46) did not.
• Data collected included demographics, diagnoses, antibiotic use, septic complications, length of stay, and mortality.

Main Results:

• No cases of empyema or bronchial fistula occurred in the group receiving intracavitary antibiotics.
• Six patients (13%) in the control group developed postpneumonectomy empyemas (5 with fistula, 1 alone) (p=0.012).
• Operative mortality was similar between groups (9% each, p=0.63).

Conclusions:

• Prophylactic intraoperative intracavitary antibiotic instillation may decrease the incidence of empyemas post-pneumonectomy.
• A randomized controlled trial is necessary to confirm the effectiveness of this prophylactic antibiotic strategy.