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Antibiotic prophylaxis in pulmonary surgery: a double-blind study of penicillin versus placebo
Abstract:
A prospective, randomized double-blind study comparing high-dose short-term penicillin-G prophylaxis with placebo was conducted on patients referred for elective pulmonary surgery. The major advantages of penicillin prophylaxis over placebo were observed for wound infections (2/45 vs 9/47, respectively, p = 0.03), postoperative antibiotic use (13/45 vs 23/47, respectively, p = 0.049), and postoperative hospital stay (median 10 days vs 13 days, respectively, p = 0.02). The prophylactic penicillin regimen had no effect on the incidence of empyema or lower respiratory tract infections. Staphylococcus aureus and Haemophilus were identified as the major pathogens in post-operative infections. Penicillin significantly reduced the incidence of S. aureus in spite of resistance to penicillin in most isolated strains, while the frequency of Haemophilus was similar in the two treatment groups. Colonization with Enterobacteriaceae and Pseudomonas aeruginosa was pronounced in the penicillin group. Few side-effects of penicillin treatment were recorded. Short-term penicillin prophylaxis is recommended, but the ideal prophylactic regimen in pulmonary surgery has not yet been found.
Insights
High-dose, short-term penicillin prophylaxis significantly reduced wound infections and hospital stays in patients undergoing pulmonary surgery. However, it did not impact other infections and showed increased colonization by certain bacteria.
Area of Science:
- Thoracic Surgery
- Infectious Disease Prevention
- Clinical Pharmacology
Background:
- Surgical site infections (SSIs) are a significant concern in pulmonary surgery.
- Optimal prophylactic antibiotic strategies remain under investigation.
Purpose of the Study:
- To evaluate the efficacy of high-dose, short-term penicillin-G prophylaxis versus placebo in preventing complications after elective pulmonary surgery.
Main Methods:
- Prospective, randomized, double-blind study design.
- Comparison of penicillin-G prophylaxis against a placebo group.
- Data collection on wound infections, postoperative antibiotic use, hospital stay, and specific pathogen incidence.
Main Results:
- Penicillin prophylaxis significantly reduced wound infections (p=0.03) and postoperative antibiotic use (p=0.049).
- A shorter postoperative hospital stay was observed in the penicillin group (p=0.02).
- No significant effect on empyema or lower respiratory tract infections; increased colonization by Enterobacteriaceae and Pseudomonas aeruginosa noted.
Conclusions:
- Short-term penicillin prophylaxis demonstrates benefits in reducing specific complications in pulmonary surgery.
- Further research is needed to determine the ideal prophylactic regimen.
- Penicillin effectively reduced Staphylococcus aureus infections despite resistance.