["Single-shot" antibiotic prophylaxis in thoracic surgery; reduction of the postoperative infection rate]

A prospective, controlled and randomised trial was started to detect the effectivity of a "single-shot" antibiotic prophylaxis in thoracic surgery using cefuroxime. Therefore 200 unselected patients, consecutively scheduled for major thoracic surgery except endoscopic procedures or mediastinoscopy were enrolled in this study and randomized into either the control group (no antibiotics perioperatively; n = 100) or the prophylaxis group (one dose of 1.5 g cefuroxime i.v. at induction of anaesthesia; n = 100). Clinical signs correlated with infection, radiological findings and the results of repeated microbiological examinations were recorded and a comparative statistical analysis was done. Compared to controls the prophylaxis group had fewer (not significant) infections of the wound, the pleural cavity and the urinary tract and fewer patients of this group showed "pronounced infiltration" in daily taken chest roentgenograms (significant), clinical signs for pneumonia and pathologic sputum findings, or new bacterial colonisation of sputum specimens on the first postoperative day, whereas bacteria, isolated from tracheal aspirates, immediately taken after intubation disappeared more often. Specimens of pleural fluid taken postoperatively were less often positive for bacteria. Fewer patients were treated with antibiotics in the postoperative course and the courses were shorter in the prophylaxis group compared to controls. Considering the risk factor "positive microbiological culture" in preoperative tracheal aspirates, patients of the prophylaxis group showed much more seldom new radiological "infiltration" (statistically highly significant) and, in addition, had lower white blood cell counts (significant) and lower mean maximal body temperatures. The results of our trial confirm the preventive effect of "single-shot" antibiotic prophylaxis in thoracic surgery against infections.