Preoperative microbiologic screening and antibiotic prophylaxis in pulmonary resection operations

Background. Pulmonary resection is associated with considerable risk of inf ection, so antibiotic prophylaxis has become routine practice in pulmonary operations. We studied two standard flash antibiotic prophylaxis regimens a nd matched them to preoperatively acquired microorganisms. Methods. In 120 patients scheduled for elective pulmonary resection, aspira tes were taken separately from the left and the right lung using a double-l umen tube. Then the patients received either 1.5 g of sulbactam plus ampici llin (n = 60; group 1) or 2 g of cefazolin (n = 60; group 2) intravenously as a single-shot antibiotic prophylaxis according to a prospective randomiz ed sequence. When bacteria were found in the aspirates, both antibiotics we re tested for susceptibility. The patients were monitored for the first 3 p ostoperative days with regard to bronchopulmonary infections. Results. Fifty-eight pathogens were isolated from the 120 patients. The cul tured bacteria did not differ significantly between the two groups. In grou p 1 all found bacteria were susceptible to the used antibiotic prophylaxis, whereas in group 2 eight of the 25 found bacteria were not susceptible to antibiotic prophylaxis. Postoperatively, group 2 showed significantly more signs of bronchopulmonary infections than the group 1 and subsequently need ed additional antibiotics more often. Intensive care unit stay was longer i n patients of group 2 and costs were higher for these patients. Conclusions. Preoperative microbiologic examination could be helpful to eva luate efficacy of the antibiotic prophylaxis regimen. Sulbactam plus ampici llin was significantly more effective than cefazolin. (C) 1999 by The Socie ty of Thoracic Surgeons.