Perioperative Antibiotikatherapie in der Thoraxchirurgie

 

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Zusammenfassung

Hintergrund: Bisher existieren in Deutschland keine offiziellen Leitlinien für eine spezielle perioperative Antibiotikaprophylaxe (PAP) in der Thoraxchirurgie. In dieser Übersichtsarbeit werden sowohl die vorhandenen Daten zur PAP als auch zur antibiotischen Therapie der postoperativen Pneumonie (POP) in der Thoraxchirurgie dargestellt. Material und Methoden: Selektive Literaturrecherche in Medline und Empfehlungen der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) sowie der Paul-Ehrlich-Gesellschaft für Chemotherapie e. V. (PEG). Ergebnisse: Die PAP ist eine kurzfristige, im Allgemeinen einmalige Gabe eines Antibiotikums vor oder in Ausnahmefällen spätestens während eines operativen Eingriffs. Durch eine PAP mit Cephalosporinen der 1. oder 2. Generation konnte die Rate an postoperativen Wundinfektionen nach thoraxchirurgischen Eingriffen signifikant gesenkt werden. In diesen wenigen randomisierten Studien konnte bisher jedoch kein eindeutiger Effekt der PAP auf die postoperative Rate an Pneumonien oder Empyemen nachgewiesen werden. Eine POP tritt in bis zu 20–25 % der Fälle nach größeren thoraxchirurgischen Operationen auf. Die antibiotische Therapie der POP sollte frühzeitig und nach Antibiogramm erfolgen. Schlussfolgerung: Basierend auf wenigen prospektiven, randomisierten Studien wird eine Empfehlung zur einmaligen intravenösen PAP mit Cephalosporinen bei thoraxchirurgischen Operationen ausgesprochen. Die Therapie der POP sollte neben allgemeinen Maßnahmen eine intravenöse antibiotische Therapie nach Antibiogramm beinhalten.

Abstract

Introduction: In Germany no official guidelines exist for a specific perioperative antibiotic prophylaxis (PAP) in thoracic surgery. In this review, data regarding the PAP as well as antibiotic therapy of the postoperative pneumonia (POP) in thoracic surgery are described. Methods: Selective literature researches were carried out in Medline with consideration of the official recommendations of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) as well as Paul-Ehrlich-Gesellschaft für Chemotherapie e. V. (PEG). Results: The PAP is defined as a short and single application of an antibiotic agent preoperatively or during a surgical intervention. A PAP with first-generation or second-generation cephalosporins could significantly reduce the rate of surgical site infections after thoracic surgery. However, these few randomised trials could not demonstrate a distinct effect on the rate of POP and postoperative empyema. The incidence of POP is approximately 20–25 % after major thoracic surgery. Antibiotic therapy of POP should be performed early and be based on antibiotic sensitivity. Conclusion: Based on the few prospective, randomised studies a single dose of intravenous PAP with a cephalosporin is recommended in thoracic surgery. Therapy of the POP should include general procedures combined with a specific antibiotic therapy according to antibiotic sensitivity.

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