SINGLE-SHOT ANTIBIOTIC-PROPHYLAXIS IN THO RACIC-SURGERY - REDUCTION OF POSTOPERATIVE INFECTION-RATE

A prospective, controlled and randomised trial was started to detect t he effectivity of a ''single-shot'' antibiotic prophylaxis in thoracic surgery using cefuroxime. Therefore 200 unselected patients, consecut ively scheduled for major thoracic surgery except endoscopic procedure s or mediastinoscopy were enrolled in this study and randomized into e ither the control group (no antibiotics perioperatively; n = 100) or t he prophylaxis group (one dose of 1.5 g cefuroxime i.v. at induction o f anaesthesia; n = 100). Clinical signs correlated with infection, rad iological findings and the results of repeated microbiological examina tions were recorded and a comparative statistical analysis was done. C ompared 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 da ily taken chest roentgenograms (significant), clinical signs for pneum onia and pathologic sputum findings, or new bacterial colonisation of sputum specimens on the first postoperative day, whereas bacteria, iso lated from tracheal aspirates, immediately taken after intubation disa ppeared more often. Specimens of pleural fluid taken postoperatively w ere 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 fa ctor ''positive microbiological culture'' in preoperative tracheal asp irates, 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 thoraci c surgery against infections.