, Volume 46, Issue 5, pp 617–624 | Cite as

Prolonged antibiotic prophylaxis after thoracoabdominal esophagectomy does not reduce the risk of pneumonia in the first 30 days: a retrospective before-and-after analysis

  • Marcel Hochreiter
  • Maria Uhling
  • Leila Sisic
  • Thomas Bruckner
  • Alexandra Heininger
  • Andreas Hohn
  • Katja Ott
  • Thomas Schmidt
  • Marc Moritz Berger
  • Daniel Christoph Richter
  • Markus Büchler
  • Markus Alexander Weigand
  • Cornelius Johannes BuschEmail author
Original Paper



Thoracoabdominal esophageal resection for malignant disease is frequently associated with pulmonary infection. Whether prolonged antibiotic prophylaxis beyond a single perioperative dose is advantageous in preventing pulmonary infection after thoracoabdominal esophagectomy remains unclear.


In this retrospective before-and-after analysis, 173 patients between January 2009 and December 2014 from a prospectively maintained database were included. We evaluated the effect of a 5-day postoperative course of moxifloxacin, which is a frequently used antimicrobial agent for pneumonia, on the incidence of pulmonary infection and mortality after thoracoabdominal esophagectomy.


104 patients received only perioperative antimicrobial prophylaxis (control group) and 69 additionally received a 5-day postoperative antibiotic therapy with moxifloxacin (prolonged-course). 22 (12.7%) of all patients developed pneumonia within the first 30 days after surgery. No statistically significant differences were seen between the prolonged group and control group in terms of pneumonia after 7 (p = 0.169) or 30 days (p = 0.133), detected bacterial species (all p > 0.291) and 30-day mortality (5.8 vs 10.6%, p = 0.274).


A preemptive 5-day postoperative course of moxifloxacin does not reduce the incidence of pulmonary infection and does not improve mortality after thoracoabdominal esophagectomy.


Pulmonary infection Antimicrobial prophylaxis Bronchoalveolar lavage Postoperative antibiotic therapy 



We would like to thank Anuradha Gunale M.D., Ph.D. for proof-reading the manuscript.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.


  1. 1.
    Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet. 2013;381:400–12. Scholar
  2. 2.
    Wu PC, Posner MC. The role of surgery in the management of oesophageal cancer. Lancet Oncol. 2003;4:481–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Blank S, Schmidt T, Heger P, Strowitzki MJ, Sisic L, Heger U, et al. Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach? Gastric Cancer. 2017. Scholar
  4. 4.
    Kinugasa S, Tachibana M, Yoshimura H, Ueda S, Fujii T, Dhar DK, et al. Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy. J Surg Oncol. 2004;88(2):71–7. Scholar
  5. 5.
    Kataoka K, Takeuchi H, Mizusawa J, Igaki H, Ozawa S, Abe T, et al. Prognostic impact of postoperative morbidity after esophagectomy for esophageal cancer: exploratory analysis of JCOG9907. Ann Surg. 2016. Scholar
  6. 6.
    Booka E, Takeuchi H, Nishi T, Matsuda S, Kaburagi T, Fukuda K, et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine. 2015;94:e1369. Scholar
  7. 7.
    Xing XZ, Gao Y, Wang HJ, Qu SN, Huang CL, Zhang H, et al. Assessment of a predictive score for pulmonary complications in cancer patients after esophagectomy. World J Emerg Med. 2016;7:44–9. Scholar
  8. 8.
    Bludau M, Holscher AH, Bollschweiler E, Leers JM, Gutschow CA, Brinkmann S, et al. Preoperative airway colonization prior to transthoracic esophagectomy predicts postoperative pulmonary complications. Langenbeck’s Arch Surg. 2015;400:707–14. Scholar
  9. 9.
    D’Journo XB, Michelet P, Papazian L, Reynaud-Gaubert M, Doddoli C, Giudicelli R, et al. Airway colonisation and postoperative pulmonary complications after neoadjuvant therapy for oesophageal cancer. Eur J Cardio Thoracic Surg. 2008;33:444–50. Scholar
  10. 10.
    WHO Guidelines Approved by the Guidelines Review Committee. Global guidelines for the prevention of surgical site infection. Geneva: World Health Organization Copyright (c) World Health Organization 2016; 2016.Google Scholar
  11. 11.
    Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70:195–283. Scholar
  12. 12.
    Barreto JC, Posner MC. Transhiatal versus transthoracic esophagectomy for esophageal cancer. World J Gastroenterol. 2010;16:3804–10.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Wacha HIR, Kujath P, Lebert C, Naber CK, Salzberger B. Perioperative antibiotic prophylaxis. Evidence based guidelines by an expert panel of the Paul Ehrlich Gesellschaft. Chemother J. 2010;19:70–84.Google Scholar
  14. 14.
    Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH Jr, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thoracic Surg. 2004;78:1170–6. (discussion—6).CrossRefGoogle Scholar
  15. 15.
    Morita M, Otsu H, Kawano H, Kumashiro R, Taketani K, Kimura Y, et al. Advances in esophageal surgery in elderly patients with thoracic esophageal cancer. Anticancer Res. 2013;33:1641–7.PubMedGoogle Scholar
  16. 16.
    Low DE, Alderson D, Cecconello I, Chang AC, Darling GE, D’Journo XB, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg. 2015;262:286–94. Scholar
  17. 17.
    Weijs TJ, Seesing MF, van Rossum PS, Koeter M, van der Sluis PC, Luyer MD, et al. Internal and external validation of a multivariable model to define hospital-acquired pneumonia after esophagectomy. J Gastrointest Surg. 2016;20:680–7. Scholar
  18. 18.
    Khan AN, Al-Jahdali H, Al-Ghanem S, Gouda A. Reading chest radiographs in the critically ill (Part II): radiography of lung pathologies common in the ICU patient. Ann Thoracic Med. 2009;4:149–57. Scholar
  19. 19.
    Klompas M. Complications of mechanical ventilation—the CDC’s new surveillance paradigm. N Engl J Med. 2013;368:1472–5. Scholar
  20. 20.
    Ferrara AM. A brief review of moxifloxacin in the treatment of elderly patients with community-acquired pneumonia (CAP). Clin Interv Aging. 2007;2:179–87.PubMedPubMedCentralGoogle Scholar
  21. 21.
    McKenzie C. Antibiotic dosing in critical illness. J Antimicrob Chemother. 2011;66:ii25–31. Scholar
  22. 22.
    Conil JM, Georges B, de Lussy A, Khachman D, Seguin T, Ruiz S, et al. Ciprofloxacin use in critically ill patients: pharmacokinetic and pharmacodynamic approaches. Int J Antimicrob Agents. 2008;32:505–10. Scholar
  23. 23.
    Pletz MW, Bloos F, Burkhardt O, Brunkhorst FM, Bode-Boger SM, Martens-Lobenhoffer J, et al. Pharmacokinetics of moxifloxacin in patients with severe sepsis or septic shock. Intensive Care Med. 2010;36:979–83. Scholar
  24. 24.
    Langdon A, Crook N, Dantas G. The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation. Genome Med. 2016;8:39. Scholar
  25. 25.
    Edlund C, Nord CE. A review on the impact of 4-quinolones on the normal oropharyngeal and intestinal human microflora. Infection. 1988;16:8–12.CrossRefPubMedGoogle Scholar
  26. 26.
    Stein GE, Goldstein EJ. Fluoroquinolones and anaerobes. Clin Infect Dis. 2006;42:1598–607. Scholar
  27. 27.
    Panda S, El khader I, Casellas F, Lopez Vivancos J, Garcia Cors M, Santiago A, et al. Short-term effect of antibiotics on human gut microbiota. PloS One. 2014;9:e95476. Scholar
  28. 28.
    Delisle MS, Williamson DR, Perreault MM, Albert M, Jiang X, Heyland DK. The clinical significance of Candida colonization of respiratory tract secretions in critically ill patients. J Crit Care. 2008;23:11–7. Scholar
  29. 29.
    Fujita TDH. Optimal duration of prophylactic antimicrobial administration and risk of postoperative infectious events in thoracic esophagectomy with three-field lymph node dissection: short-course versus prolonged antimicrobial administration. Esophagus. 2015;12:38–43.CrossRefGoogle Scholar
  30. 30.
    Sharpe DA, Renwick P, Mathews KH, Moghissi K. Antibiotic prophylaxis in oesophageal surgery. Eur J Cardio Thoracic Surg. 1992;6:561–4.CrossRefGoogle Scholar
  31. 31.
    Naf F, Warschkow R, Kolb W, Zund M, Lange J, Steffen T. Selective decontamination of the gastrointestinal tract in patients undergoing esophageal resection. BMC Surg. 2010;10:36. Scholar
  32. 32.
    Price RJ, Cuthbertson BH. Selective decontamination of the digestive tract and oropharynx: after 30 years of debate is the definitive answer in sight? Curr Opin Crit Care. 2016;22:161–6. Scholar
  33. 33.
    Huttner A, Harbarth S, Carlet J, Cosgrove S, Goossens H, Holmes A, et al. Antimicrobial resistance: a global view from the 2013 World Healthcare-Associated Infections Forum. Antimicrob Resist Infect Control. 2013;2:31. Scholar
  34. 34.
    Yu VL, Singh N. Excessive antimicrobial usage causes measurable harm to patients with suspected ventilator-associated pneumonia. Intensive Care Med. 2004;30:735–8. Scholar
  35. 35.
    Kobayashi M, Takesue Y, Kitagawa Y, Kusunoki M, Sumiyama Y. Antimicrobial prophylaxis and colon preparation for colorectal surgery: results of a questionnaire survey of 721 certified institutions in Japan. Surg Today. 2011;41:1363–9. Scholar
  36. 36.
    Imamura H, Furukawa H, Iijima S, Sugihara S, Tsujinaka T, Tsukuma H, et al. Multicenter phase II study of antimicrobial prophylaxis in low-risk patients undergoing distal gastrectomy for gastric cancer. Gastric Cancer. 2006;9:32–5. Scholar
  37. 37.
    Behnke M, Hansen S, Leistner R, Diaz LA, Gropmann A, Sohr D, et al. Nosocomial infection and antibiotic use: a second national prevalence study in Germany. Deutsches Arzteblatt Int. 2013;110:627–33. Scholar
  38. 38.
    Gordon AC, Cross AJ, Foo EW, Roberts RH. C-reactive protein is a useful negative predictor of anastomotic leak in oesophago-gastric resection. ANZ J Surg. 2016. Scholar
  39. 39.
    Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:e61–e111. Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Marcel Hochreiter
    • 1
  • Maria Uhling
    • 1
  • Leila Sisic
    • 2
  • Thomas Bruckner
    • 3
  • Alexandra Heininger
    • 4
  • Andreas Hohn
    • 5
  • Katja Ott
    • 6
  • Thomas Schmidt
    • 2
  • Marc Moritz Berger
    • 1
    • 7
  • Daniel Christoph Richter
    • 1
  • Markus Büchler
    • 2
  • Markus Alexander Weigand
    • 1
  • Cornelius Johannes Busch
    • 1
    Email author
  1. 1.Department of AnesthesiologyHeidelberg University HospitalHeidelbergGermany
  2. 2.Department of General, Visceral and Transplantation SurgeryHeidelberg University HospitalHeidelbergGermany
  3. 3.Institute of Medical Biometry and InformaticsHeidelberg University HospitalHeidelbergGermany
  4. 4.Department of Infectious DiseasesHeidelberg University HospitalHeidelbergGermany
  5. 5.Department of Anesthesiology and Intensive Care MedicineUniversity Hospital of CologneCologneGermany
  6. 6.Department of SurgeryRoMed KlinikumRosenheimGermany
  7. 7.Department of Anesthesiology, Perioperative and General Critical Care Medicine, University Hospital SalzburgParacelsus Medical UniversitySalzburgAustria

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