Authors: Simon Turner and Anne-Sophie Laliberté
BACKGROUND
The inappropriate use of antibiotics may contribute to antibiotic resistance, may lead to C. difficile infection, and is associated with increased cost.
This set of recommendations addresses pre and postoperative use of prophylactic antibiotics in elective lung and esophageal resections. These are assumed to be “clean-contaminated” operations in which the lung or digestive tract is opened or incised under controlled conditions, and we assume the absence of an active infection or complication.
RECOMMENDATION
Preoperative antibiotics for lung resection
- Pre-operative antibiotics should be given. They contribute to reducing post-operative wound infection as part of a wider strategy including skin preparation, surgical hand scrubbing, double gloves, intraoperative normothermia, and optimal blood glucose. While mostly given to reduce wound infection there is one article proving the reduction in postoperative pneumonia and empyema.
- Choice of prophylactic antibiotic should be dictated by the pathogens most likely to cause wound infection in your center and adjusted to local antibiotic resistance.
- Prophylactics antibiotics should be given within 1 hour before skin incision and weight-adjusted. It should be re-dosed during surgery.
Preoperative antibiotics for esophagectomy
- Pre-operative antibiotics should be given, for the same reasons as above, as they have shown to reduce wound infection and organ/space infection. Antibiotic selection should include coverage for skin and enteric organisms.
- For colonic interposition, the choice of prophylactic antibiotic should be adjusted as to colorectal surgery.
Postoperative antibiotics for lung resection
- Post-operative antibiotics should not routinely be used following lung resection. Existing guidelines focus on surgical site infection prevention (i.e. not explicitly studying pneumonia or empyema) and we found no evidence supporting post-op antibiotics for this purpose. We found only one small retrospective study supporting reduced postoperative pneumonia with a short (72h) post-operative antibiotic course, but no other evidence supporting their use.
Postoperative antibiotics for esophagectomy
- Post-operative antibiotics should not routinely be used following esophagectomy. Most studies extrapolated data from general surgery literature including gastric resections and showed no benefit.
REFERENCES
Allegranzi B, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: An evidence-based global perspective. Lancet Infect Dis. 2016;16:e288-303.
Ban KA, et al. American College of Surgeons and Surgical Infection Society: Surgical site infection guidelines, 2016 Update. J Am Coll Surg. 2016;224(1):59-73.
Batchlor TJP et al. Guidelines of enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS) Society and the European Society of Thoracic Surgeons (ESTS), European Journal of Cardio-Thoracic Surgery. 2019;55:91-115.
Berrios-Torres SI. Centres for Disease Control and Prevention guideline for the prevention of surgical Site infection, 2017. JAMA Surgery. 2017;152(8):784-791.
Chang SH, Krupnick As. Perioperative antibiotics in thoracic surgery. Thorac Surg Clin. 2012;22(1):35-45.
Deguchi H, et al. Influence of prophylactic antibiotic duration on postoperative pneumonia following pulmonary lobectomy for non-small cell lung cancer. J Thorac Dis. 2019;11(4):1155-1164.
Low DE, et al. Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J. Surg (2019) 43:299-330.