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Amoxicillin-clavulanic acid resistance in the first postoperative pneumonia after cardiac surgery: Risk factors and outcomes from a 10-year cohort analysis

  • 0Department of Anesthesiology and Critical Care Unit, Institut Mutualiste Montsouris, Paris Cite University, Paris, France.
Anaesthesia, Critical Care & Pain Medicine +

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September 28, 2025

|

September 28, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Postoperative pneumonia (POP) after cardiac surgery (CS) is often caused by resistant bacteria. Amoxicillin-clavulanic acid-resistant POP (AMC-R POP) significantly increases intensive care unit (ICU) stays and reduces survival.

Area Of Science

  • Infectious Diseases
  • Critical Care Medicine
  • Surgical Infections

Background

  • Postoperative pneumonia (POP) is a serious complication following cardiac surgery (CS).
  • A significant proportion of POP cases involve pathogens resistant to common antibiotics like amoxicillin-clavulanic acid (AMC).

Purpose Of The Study

  • To identify risk factors associated with AMC-resistant POP (AMC-R POP).
  • To evaluate the clinical outcomes, including ICU length of stay and survival, for patients with AMC-R POP.

Main Methods

  • A single-center retrospective cohort study of CS patients who developed POP within 7 days post-surgery.
  • Comparison of clinical characteristics and outcomes based on AMC susceptibility of the causative pathogens.
  • Multivariate analysis to determine independent risk factors and outcome associations.

Main Results

  • 53% of POP cases were AMC-resistant, with AmpC-producing Enterobacterales and Pseudomonas aeruginosa being common pathogens.
  • AMC-R POP was independently associated with a longer ICU length of stay (7.0 days longer).
  • AMC-R POP correlated with reduced 90-day survival and was linked to redo surgery, multiple procedures, and high SAPS II scores.

Conclusions

  • AMC-R POP is prevalent after CS and significantly impacts patient outcomes, increasing ICU stay.
  • Risk factors for AMC-R POP include redo surgery and high severity scores upon ICU admission.
  • Empirical antibiotic strategies for suspected POP in high-risk patients should consider AMC-resistant pathogens.

Keywords:

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