'Single-Shot'-Antibiotika-Prophylaxe in der Thoraxchirurgie

Thoracic (lung) surgery is particularly charged with complications of infection. Antibiotic prophylaxis (APr) is commonly performed; significant beneficial effects are still unproven. In a randomized controlled trial, a ¿single-shot¿ APr with 1.5 gr cefuroxime was performed in a total of 200 patients (control/test group; both 100 pat.).

Post-operative wound / pleural / urinary tract infections and clinical signs of infection / pneumonia were less frequent in the APr group. Bacteriological examinations prove a relevant reduction of tracheo-bronchial existing germs as well as the prevention of intubation-related new colonization. Consecutively, antibiotic therapy is less frequent after APr, with lower costs overall.

Substantial and multiple significantly more favorable results after APr are found for the sign ¿infiltrate¿ in chest radiographs. The frequency and severity of infiltrates often correlate significantly with leukocyte counts and gas exchange measurements. Thus, the ¿infiltrate¿ often characterizes inflammatory lung changes. Defined risks (malignancy, age, smoking, obesity, obstruction, positive germ detection tracheo-bronchial) show multiple (highly) significant correlations to the sign ¿infiltrate¿ in elaborate statistical analyses. It has been shown that especially non-risk patients benefit from APr; the ¿non-prophylaxis¿ (control group) proves statistically to be an independent pneumonia risk.

CONCLUSION: A ¿single-shot¿ APr establishes clinical advantages for thoracic surgical procedures. Furthermore ¿ and more significantly ¿ it is proven that antibiotic colonization / infection prophylaxis is possible for ¿internal¿ ¿ tracheal and pulmonary ¿ ¿surfaces¿. The findings should be noteworthy with regard to obligatory pharyngo-tracheal germ carriage during standard intubation.