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Antibiotic therapy of postoperative bronchopneumonia in patients after lung resections - single-site experience
Introduction:
Infectious complications after lung surgery are the most important factor that affects mortality and morbidity, prolongs hospital stays and increases financial costs. According to various sources, 30-day mortality after lung resections reaches 123%. Infectious complications account for 2075% of overall mortality. The infections most often present as postoperative pneumonia (POP), and their treatment is based on empirical and targeted antibiotic therapy. Any time lag in initiating effective antibiotic therapy significantly increases morbidity and mortality. Postoperative pneumonia is defined according to current guidelines of the American Thoracic Society of 2016 as nosocomial or ventilator pneumonia in patients after surgery.
Methods:
Evaluation of risk factors, infectious agents, morbidity and mortality in patients after lung resections at a single site in the period from 1 January 2018 to 31 December 2019.
Results:
Of our group of 190 patients, 21 (11.1%) patients had POP which was severe in 6 (33% with POP) patients, and 11 patients with POP required artificial oxygenation for saturation below 92%. Two patients with POP had to be intubated for respiratory failure, and 3 patients required noradrenaline circulatory support. One patient with severe POP died of multiorgan failure after developing refractory sepsis.
Conclusion:
Early identification of lung infection and early initiation of POP therapy are critical points for reducing morbidity and mortality after lung resections. Advanced antibiotic regimens for POP stratify the risk of mortality and infection with multidrug-resistant bacterial strains. However, the regimes require modification according to the epidemiological situation at the site with individualization of the specific procedure. Other research tasks include identification of valid markers of the initial stages of infection, and targeting of antibiotic therapy according to risk stratification and the relationship with physiological flora.
Insights
Early identification and treatment of postoperative pneumonia (POP) after lung surgery are crucial for reducing patient mortality and morbidity. Tailoring antibiotic regimens to local epidemiology and individual patient risk factors is essential for effective POP management.
Area of Science:
- Thoracic Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Infectious complications significantly increase mortality, morbidity, and costs following lung surgery.
- Postoperative pneumonia (POP) is a primary infectious complication, necessitating prompt antibiotic therapy.
- Delayed treatment of POP is directly linked to increased patient mortality and prolonged hospital stays.
Purpose of the Study:
- To evaluate risk factors, infectious agents, morbidity, and mortality associated with POP after lung resections.
- To analyze the impact of POP on patient outcomes in a single-center study.
- To inform strategies for early detection and management of POP.
Main Methods:
- Retrospective analysis of 190 patients undergoing lung resections between January 2018 and December 2019.
- Identification and characterization of infectious agents causing POP.
- Assessment of clinical outcomes, including severity of POP, need for respiratory support, and mortality.
Main Results:
- Postoperative pneumonia (POP) occurred in 11.1% of patients (21 out of 190).
- Severe POP affected 33% of patients with POP, requiring interventions like artificial oxygenation, intubation, or circulatory support.
- One patient with severe POP died due to multiorgan failure secondary to refractory sepsis.
Conclusions:
- Early detection and initiation of POP therapy are critical for improving outcomes after lung resections.
- Advanced antibiotic strategies for POP should consider multidrug-resistant strains and be adapted to local epidemiology.
- Future research should focus on identifying early infection markers and tailoring antibiotic therapy based on risk stratification and host-pathogen interactions.
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