Optimal Duration of Antibiotics Therapy After Video-assisted Thoracoscopic Surgery in Thoracic Empyema and Complicated Parapneumonic Effusion

BackgroundThere is no evidential report about the optimal duration of antibiotic use following video-assisted thoracoscopic surgery debridement (VATS-D) in thoracic empyema (TE) or complicated parapneumonic effusion (PPE). The purpose of this study was to determine the optimal duration of antibiotic therapy after VATS-D for TE /PPE.MethodsBetween January 2011 and December 2019, total thirty-three patients (28 men, 5 women; median age 63 years) corresponding to ACCP category 3 or 4 receiving VATS-D were included in the study. Time until the body temperature (BT) was to be less than 37.5 ºC and 37.0 ºC, WBC count to be less than 10,000/μl and segmented neutrophil (seg) count to be less than 80% were retrospectively analyzed.ResultsThe median time from the onset of TE/PPE to the operation was 13 days. Pre and postoperative antibiotic had median values of 5 and 7 days, respectively. There were no hospital deaths within 30 days of the operation. Major complications occurred in 4 cases (3 respiratory failures and one celebral infarction). Median postoperative hospital stay was 14 days. Success rate in TE/PPE treatment was 88%. The median number of days until the conditions met were BT>37.5 ºC for 3 days, BT>37.0 ºC for 6 days, WBC<10,000 for 4 days and seg<80% for 7 days.ConclusionThe optimal antibiotic duration of antibiotic use after VATS-D for TE/PPE is approximately 5 days. Urgent VATS-D will shorten the total antibiotic duration.