ANTIBIOTIC-PROPHYLAXIS IN PULMONARY SURGERY - A PROSPECTIVE RANDOMIZED DOUBLE-BLIND TRIAL OF FLASH CEFUROXIME VERSUS 48-HOUR CEFUROXIME

The aim of this study was to determine whether a 48-hour antibiotic pr ophylaxis regimen with a second-generation cephalosporin was more effi cient than a flash antibiotic prophylaxis regimen in pulmonary operati ons. All the included patients underwent lung resection. Patients with preoperative infection were excluded. All the patients were given cer furoxime (1.5 gm intravenously) at the time of the anesthesic inductio n and again 2 hours later. The randomization was done postoperatively: group 1 was given placebo intravenously (n = 102) and group 2 was giv en cefuroxime intravenously (n = 101), each every 6 hours for 48 hours . The overall rate of infections was 46% in the 48-hour cefuroxime gro up versus 65% in the flash group (p = 0.005). The difference remained significant even after an adjustment with prognosis variables (p = 0.0 1). Six empyemas (6%) in the hash group were noted versus one (1%) in the 48-hour group (p = 0.03). From day 3 to day 8 after the operation, chest x-rays films were more often assessed as being normal in the fl ash group than in the 48-hour group (p = 0.005). On day 3 after operat ion, white blood cell counts were 13,020 +/- 1,220 elements/mm(3) in t he flash group versus 11,620 +/- 1,220 elements/mm(3) in the 48-hour g roup (p = 0.03). A 48-hour antibiotic prophylaxis regimen decreases th e rate of deep infections and particularly the rate of empyemas.