Background

The study of the bacterial cartography in thoracic surgery is extremely important for the treatment of post-operative infections due to the severity of the underlying pathology, the fragility of patients after surgery in addition to the choice of the empiric antibiotherapy.

The purpose of our work was to study the bacterial epidemiology and to identify the most common bacterias, as well as the impact of an adapted antibiotherapy on the patient’s’ prognostic.

Materials/Methods

We led a prospective study following all the patients who underwent a pulmonary resection surgery for a period of 7 months from January to July 2016, jointly with the microbiology department in Ibn Rochd Universitary Hospital, Casablanca. The bronchial secretions were collected by a protected distal bronchial sample using a (combicath) after the intubation.

Results

During the period of the study, 92 patients underwent a pulmonary resection, 65% for a neoplasic pathology. The medium age was 43 years +/-8 and 58% were male. 48% of our patients had smoking habits and 16 of them had pulmonary tuberculosis, 12 had repeated respiratory infections. The antibiotics used in pre-operative: 58% of beta-lactams; 22% of fluoroquinolones; 5% of macrolides. Moreover, 60% of our patients were classified ASA1.
Of the 92 obtained samples, 22 were positive (23,9%). The most frequently observed germs were the acinetobacter baumannii (8.7%), pseudomonas aeruginosa (6.5%), klebsiella pneumoniae (4.3%), staphylococcus aureus (4.3%). The acinetobacter baumannii was the most resistant germ (60% sensibility to carbapenem). These patients were followed until their 30th day after surgery, 12 of them developed a post-operative pneumonitis with 4 cases of multi-resistant acinetobacter baumanii, 2 of which died.

Conclusion

Pneumonitis after pulmonary resection are frequent  and severe. It is thus necessary to establish a global prevention strategy mainly based on general praticians’ and pneumologists’ awareness concerning the choice of the prescribed antibiotics, in order to avoid the spread of multi-resistant germs

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