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[Adequate Perioperative Use of Antibiotics in Thoracic Surgery]
Michael Jan Engelhardt1, Susanne Bornemann2, Joachim Pfannschmidt2
1Klinik für Pneumologie - Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring GmbH, Berlin.
Introduction:
Infectious complications after lung resections pose a high burden of perioperative morbidity and mortality. Among other factors, perioperative antibiotic prophylaxis and management of a postoperative pneumonia have an impact on patient outcome. We developed a local clinical pathway for adequate perioperative use of antibiotics.
Methods:
We analysed respiratory samples of 200 patients taken before and after lung resection performed in our lung clinic from October 2013 till October 2014. The clinical pathway was based on our local pathogen and resistance pattern as well as on current guidelines and on the principals of antibiotic stewardship.
Results:
Gram negative bacteria were the predominant pathogens that grew from the samples in the preoperative phase (62%), as well as in the postoperative phase (78%). A significant number of these bacteria showed intrinsic resistance against the commonly used antibiotics for perioperative prophylaxis. This was the case for both the preoperative phase (21%) and the postoperative phase (39%). These findings were integrated into the local clinical pathway.
Conclusion:
The commonly used antibiotics for perioperative prophylaxis in thoracic surgery cover only some of the pathogens responsible for preoperative airway colonisation and postoperative pneumonia. Therefore, perioperative antibiotic prophylaxis should be given as a single shot just before surgery and postoperative pneumonia should be treated as a hospital acquired pneumonia with respect to the local pathogen and resistance pattern.
Insights
Perioperative antibiotic prophylaxis in lung surgery is often inadequate due to resistant pathogens. A new clinical pathway, informed by local resistance patterns, guides appropriate antibiotic use to improve patient outcomes.
Area of Science:
- Thoracic Surgery
- Infectious Diseases
- Antimicrobial Stewardship
Background:
- Infectious complications following lung resections significantly increase patient morbidity and mortality.
- Perioperative antibiotic use and pneumonia management are critical factors influencing outcomes.
- A local clinical pathway was developed to optimize perioperative antibiotic administration.
Purpose of the Study:
- To evaluate the effectiveness of a local clinical pathway for perioperative antibiotic use in lung resections.
- To identify prevalent pathogens and their resistance patterns in patients undergoing lung surgery.
- To inform antibiotic prophylaxis and treatment strategies based on local data and guidelines.
Main Methods:
- Analysis of respiratory samples from 200 patients before and after lung resection (October 2013-October 2014).
- Development of a clinical pathway incorporating local pathogen/resistance data, guidelines, and antibiotic stewardship principles.
- Integration of findings on pathogen prevalence and resistance into the clinical pathway.
Main Results:
- Gram-negative bacteria predominated preoperatively (62%) and postoperatively (78%).
- Significant intrinsic resistance to common prophylactic antibiotics was observed preoperatively (21%) and postoperatively (39%).
- These resistance patterns informed the development and refinement of the local clinical pathway.
Conclusions:
- Current perioperative antibiotics for thoracic surgery offer limited coverage against common pathogens causing airway colonization and pneumonia.
- Single-dose perioperative antibiotic prophylaxis just before surgery is recommended.
- Postoperative pneumonia should be treated as hospital-acquired pneumonia, considering local pathogen and resistance profiles.
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