[Guidelines for antibiotic agents in the field of respiratory tract surgery]

This paper provides information on the use of antibiotic agents during the postoperative period from three aspects. 1) It is important to evaluate the risk factors of postoperative infection based on the patient's preoperative condition. Diseases treated with respiratory tract surgery are frequently caused by heavy smoking. Therefore it must be remembered that the patients may have low respiratory function. 2) In the prevention of postoperative infection, the special circumstances after respiratory surgery (e.g., the disintegration of the clearance system in the airway caused by the dissection of lymph nodes, the suppression of respiration, and cough caused by thoracotomy accompanied by resection of the ribs) must be considered. Therefore we usually administer antibiotic agents for 3 to 4 days. In general, we select second-generation cephalosporins, be cause gram-negative rod infection frequently occurs. 3) Postoperative infection is diagnosed based on fluctuations in fever, laboratory data (number of white blood cells and C-reactive protein), chest X-ray findings, and properties of drainage fluid. When bacteria are not identified, we must consider MRSA as a gram-positive bacterium and Pseudomonas aeruginosa as a gram-negative bacterium. After the identification of bacteria causing the infection, the antibiotic agents may be changed based on the results of sensitivity tests. The appropriate usage of antibiotic agents in the field of respiratory tract surgery is discussed based on actual clinical experience in our department.