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Original Articles: General Thoracic

Invited commentary

Thoracic Unit, Nottingham University Hospital, Hucknall Rd, Nottingham NG5 1PB, United Kingdom

(Email: david.beggs{at}nuh.nhs.uk).

All thoracic surgeons are familiar with the unfortunate situation in which a patient has an initially uncomplicated recovery from surgery after an appropriate and technically excellent resection, but then they start to worsen clinically, develop minor atalectatic changes on chest roentgenograms, deteriorating into a proven chest infection. Then there can follow a cascade of complications that take their toll on the patient, the surgeon, the critical care staff, and the facilities of the hospital. Radu and colleagues [1] have highlighted current information to show that more than 20% of patients undergoing a pulmonary resection will develop pneumonia in the first 5 postoperative days, despite the best standard of care. Worse yet, their data indicates that as many as 25% of these patients may succumb to their disease. Although any method of minimizing the problem is to be encouraged, these authors challenge the current guidance. They have shown that the current usage of prophylactic antibiotics is unlikely to be effective in preventing this problem, as it was evidenced in their series that 84% of organisms present at the time of surgery within the bronchial tree were not sensitive to a common prophylactic antibiotic regime.

Although accepting that the intended value of prophylactic antibiotics at the time of surgery is to prevent wound infection, many surgeons hope that in continuing these antibiotics they may prevent the onset of postoperative pneumonia. This article shows that this approach is flawed in that the wrong organisms are targeted by the currently recommended antibiotic regimes. Every effort should be made to control the factors that may influence the development of pneumonia in this situation. Postoperative atelectasis after pulmonary surgery should be aggressively managed before it deteriorates into pneumonia. We should also encourage their efforts to study and evaluate new and more adaptive approaches to antibiotic prophylaxis.

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1. Radu DM, Jauréguy F, Seguin A, et al. Postoperative pneumonia after major pulmonary resections: an unsolved problem in thoracic surgery Ann Thorac Surg 2007;84:1669-1674.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): David Beggs Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Beggs, D. Search for Related Content PubMed PubMed Citation Articles by Beggs, D. Related Collections Lung - other Related Article