surgery. Prophylactic antibiotic usage in cardiothoracic

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M.D.; James. L. Cox,. M.D.;. Myron J. Jacobson,. M.D.;. James. K. Kirklin,. M.D.;. Joseph. LolCicerol,III, M.D.;. Richard. B. McElvein,. M.D.;. Darroch. W. 0. Moores,.
Prophylactic antibiotic usage in cardiothoracic surgery. J LoCicero, 3rd Chest 1990;98;719-723 DOI 10.1378/chest.98.3.719 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/98/3/719.citation

Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright1990by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692

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f__ .

accp section report

-=-

Prophylactic Surgery* Joseph

U

Antibiotic

LoCicero,

III,

M.D.

(Chest

of peniolperative

se

surgical

procedures

for

has been

established

98:719-23)

in

cardiothoracic for many

everyday mittee

the actual use of these agents in practice is not known. The Steering Comof the Section of Cardiothoracic Surgery sun-

veyed

the

College use

surgical

Physicians

prophylactic

(If

is a report

of

membership

of Chest

agents

of the

the

to determine at this

findings

time.

of the

practice

percent

However,

I

in Cardiothoracic

F.C.C.1?

,

1990;

antibiotics

Usage

and

20.7

five

years.

American

tions

noncardiac

The

following

sumrvey.

per

had

year

Qtiestionnaires

created

to) all members olfthe mailed,

The

were

ofthe collected,

and ended

practices.

anonymously.

College

own

General

practice,

and

age

divided

into

cardiac

greatest

infolrmation

duration

iy specific

in

fall

of 1988.

Each

experience

questions

in order was

and

this

400

surgeons

concerning

member

and was

the asked

type

antibiotics to

of antibiotics,

of

were

the

provide timing,

information

percent

seven

for

percent

congenital

insertions.

Among Table

returned

eight

were

percent private

of all practice.

versity

medical

were The

*In cooperation Committee, John C.

sumitable

for

analysis.

types

the Section

practice.

(adult

they

percent

Table

surgery.

ofCardiothoracic

Stmrgery

antibipercent Sixtyantibiotic Seventy-

surgical

pro-

of Respondents

been Steering

American Colllege of Chest Physicians. MEMBERS: Alexander, Jr. , M.D.; Manjit S. Bains, M.D.; John R. Benfield, M.D.; James L. Cox, M.D.; Myron J. Jacobson, M.D.; James K. Kirklin, M.D.; Joseph LolCicerol, III, M.D.; Richard B. McElvein, M.D.; Darroch W 0. Moores, M.D.; G. Alexander Patterson, M.D.; D. Glenn Pennington, M.D.; Norman A. Silverman, M .D.; Kevin Turley, M.D. Reprint requests: Dr. IA)CiCe1-O, Northwestern University Medical School, 303 East Chicago Avenue, 9-10.5, Chicago 60611-30()8

Cases

amid pediatric)

per

Year

41,677 22,610 10,040

2-Routine

Prophylactic by Procedure)

Procedures

Percentage

Antibiotics

oif Respondents

Cardiac

Valve

had

Ninety-

or defibrillator

thoracic

Caseload

(Usage

Coromiary

of practices. (48 percent)

used

pacemaker

thoracic

Seventy

Six

2.

or replacement.

Pacemakers

responded to) this qumestionof29.5 percent. All question-

of respondents with

of

Section

surgeons surveyed were in full-time Twenty-four percent were in a uniother

majority

of the

antibiotics.

prophylactic Ninety-six

that

general

1 -Operative

Cardiac

members

center-based

in various

the

75,000

procedures

in Table

heart for

expeni-

year.

in which

Procedure

Cardiothoracic Surgery naire for a response rate names

this

the

per

repair

22,610

nearly

prophylactic

stated

used

than

pacemak-

represents

was

used

for valve

operation.

and

asked

ofsurgeons

were

10,040

performing

is summarized

Noncardiac

hundred

There and

stmrvey

routinely

tmsed antibiotics

15 years, less

and

RESULTS

Four

for

procedures

question

prophylaxis

collected

of practice,

first

This

one

duplicatiomi and

procedures type

survey

1988,

stmrgical

surgeons

in practice

performed.

Thus,

these

Thirty-one than

one percent of all surveyed gave otics for coronary bypass patients.

prepared,

to avoid

size

time Oflice

for the of

on prophylactic

noncardiac

The

provided

included

Qtmestions

section.

assistance spring

mailed

At the

Physicians

the

information

range.

in this

statistical

in the

College.

ofChest

mailed

All

of the

members

provided

on his or her

groiip

1,383

were

period

to report

section

American

questionnaires

collection in

there

surgical

were

years.

more

procedures,

ence The

Committee

been

ens inserted.

MATERIALS

the Steering

by

of the

survey,

olfEducation

AND

15 for

the caseloads ofthese surgeons. estimate, 41 ,677 cardiac opera-

were

thoracic

of over

and

in practice

percent

cardiothoracic METhoDs

five

been

Table 1 summarizes By the surgeons’ own

the

actual

between had

artery

91.2

bypass

repair/replacement

Congenital

96

heart

61.3

Pacemaker/defibrillatolr

77.7

Noncardiac Pulmonary

resectiolns

80.9

Esophageal

resections

77.7

Other

52.2

esophageal

Trauma

65.9

Open

lung

h)iopsy

Tube

thoracostolmy

51.0 13.7

CHEST

I 98

I 3 I SEPTEMBER,

Downloaded from chestjournal.chestpubs.org by guest on December 30, 2011 © 1990 American College of Chest Physicians

1990

719

Table

3-Choice

ofProphyhictic

Antibiotic

(Single

Cardiac, (ephialospolrimi

(earl

(ephialos)oIrimi

(late

gemioratiomi)

Nom,cardiac,

7c

57. 1 32.

generation)

1

included

I .7

1 .0 0.7

8.4

host

used

1(X)

4-Choice

Table

ofProphy!actic

(Penicillin

35

Allergic)

\‘l)o) ere

and

N(Imicardmao.’,

Cep)ialosporimi

(all

C4

1)ercent

or

44.9 34.2

imitraoperative

(lindamiivcimi

10.5

11.1

Surgeomis

5.2

5.5

Amnimioglvcoside Other

5.1

T(Itdl

cedures,

1)tmlfli0m)trY

had

tio)Ils

high

rates

and

Percelit

1)erceimt tiolmial

Sixty

traumiia,

while

I)iopsies.

In

The

olfthe

percemit only the

five

Fifty-twol

amitibioltics

used

themii

perfolrmed

13. 7 percent

imi opemi

1)ro)cedure of

(If

stlrgeo)mis

most

coniiiion 3). This

rolutimiely

was

amitibiotic

used for

a cephalo)-

followed

80 percent

( 16.7

by less

used

than

2 percent

surgeolmis.

Some phylaxis

strgeons

for

by

valve

The group.

as a routine.

tmsing

The

niolst

comiibinatiolml

oIfliflioIfl

pro)-

combination

longer

tliaui

PREOP

SURGERY

& INTRAOP

DOSING

by

(12.6

For general

(52.2 (Fig

20

10

IN

OR

IN

PUMP

4HRS

TIMING l’mcopcmativc

dml(l imltmaol)(mativc

(l(ISeS

holurs.

Nearly

hours,

and

folr

five

days. for

perfolrmnillg

length

(IfliI)1OIi

(49

.

of

7 percent),

and

day

IIk!

40.8

oI)erating

1)ro)cedtmre

percemit

gave

4). to) give

days,

Prophylactic

(If

For

tinie

17 percellt

Antibiotics

priolr

gave

thami

a dose

after

I)ro)cecl

tires

for comic (Ia;

in Cardiothoracic

Downloaded from chestjournal.chestpubs.org by guest on December 30, 2011 © 1990 American College of Chest Physicians

con

antibiotic

resectiomis, twol

hours. stmrgeons

(If’ po1stperati\e

for

f’our

at four

six

amiiong

su rgical

to)

intraop-

longer

a dolse

ptmlmiiomiary’

antibiotics

percent)

night

to give

divergence

tlioracic

length

lasted

chose

stmr-

comm-call

(42.9

the

surgeoms

(If

percent

niost either

rooni

a dose

percent

colmmsicleral)le

(Fig

I)rolcecltires, antil)iotics

gave

gemieral

chose

three

80 40

the

cerning

surgical the

in

if’ the

\as

therapy olusiug dmimiiig cam(hi,,c

(I

Nearly

erative

cemit

this

antibiotics

stirgeons

milolst

their

percent

Folur

)erfoIrniimig CALL

days

to) give

Percent) 3).

There 0

for

the

as two) (lays (25.8 percemit),

tholracic

chose

stmrger

720

three

for

for three

amitil)i(Itics

the

percent).

lolmiger

antibiotics

Aniolmig

days

1)ercemit).

geons

30

days.

(40.8

to) l)e gave

three

of antibiotics

days

colmitintieci

amitil)iotics

followed

two

coro-

1)ercemit),

amid

leiigth

most

for

(54.6

percent),

gave

1)rce(ltmres,

1)StoII)erati\’e

PERCENT 40

F’mctum: 1 . surgery.

seven

days

tended

stmrgeomis

anti-

The

amitil)ioltics

Percemit

of

car-

1)o)stoll)erative

colnimoln

19 1)ercelit

1)ercent

imiitial (If

surgeomis.

two

was

Twenty-sevemi

preferred

following SeIlSatiolmi

of

of

(17.4

miiolst

amitil)ioltics

(If

pediatric

CARDIAC

length

replacement

while

One

day

was after

9 1)ercemit).

was

The

no

dose was

stmrgeolmis houmrs

)f postoperative

(

omw

lemigth

imltrao)perative timiiing

group

surgery

dosage used

COIflIii0Il

fllllolwing .

the this

length

iercent).

days, preferred

(1 6

the

percent

Sonic

l)Y1)asS

amitibioltic

1)laced

0.5

six

or

by

bypass

was

as primary single agent prophyand miolmicardiac procedures.

o)CCasionally

comri miion

mieanly

An 10(1st (lose

2 outlines used

bioltics

miary

accounted

used cardiac

Figtmre

ltmng tube

1)ercemlt

1)ercellt)

and

1)iolcedumres.

1)ro)PliYlactic

and

percent).

diopulmiiolmiarv

cardiac

(38.5 percemit) or in the Three I)ercemit gave a

0.8

antibiotic

(28.7

incisiomi in

(36.6

an

the

miiachiimie,

antillioltics. given. The

hours

givimig

Vanco-

I)reo)I)erative

(If fllr

ott-call percemit).

befolre,

l)VpaSs

1)re1)eIati\’e frequently

(80.9

amitil)ioltics.

for

the

propliy’laxis

prophylactic

51 1)ercelit

(Table

Penicillin

resec-

respectively).

umsed

widely ollil\’

antibiotics l)o)tli

laxis

(If

percemit,

proI)hylactic

spolnin

esophageal

su rgeons 1)erformii ing other nomiresec1)rocedumres used 1)rol)liYlactic anti-

thoracoIstoIni; used

aiI(l

antibiotic

(If

77.7

(If the esophageal

biotics.

resectiomis

timing

giving

(38

miight

the

1)0th

for

4).

comiimiiomm at approximately

dolses

eitlwr

the

in

timne

(Table

amiiinoglvcoside.

the

preferred

rOoIfli

(loSe

an

antibioltic

o)erating

1(X)

cephalolspolnimi,

the

(If

percent of surgeolmis preferred coInhl)ining either ceplialosporin

vith

Preolperati\elY

4.3

1(X)

miiost

1 ShoWs

43.9

(2 percemit),

as

iercent

SecOlid

vamicoiiivciii

35.3

per-

penicillin-allergic,

drug

I)r(Icedtlres

Seventeen agents

.

Figure

Vamicommivcimi

go.mioriti(Im1s)

44

t1it:

co)flhl)iliation Cardiae’, (‘4

colmisidered

no)ncardiac

was

( 17 )rof)hylaxiS

anil)icilliml

tltermiative

approxiniatelv

miiycin

Antibiotic

(7 percent),

(15

(I .7 percent).

CO)IiiIiiO)II

cardiac

cephalosponin

vith tnhinoIglycoside umsed fllr coIflilIine(l

ienicillimi

Iii 1)atiemits

the

l3.S

1(X)

1)ercellt) in cOflil)iilatioml cent). Other agents dm111 miiethycillin

0.7

generation

thir(l

or

If). 1

Pemiicillimi Othcr

C%

t secoln(l

54.4

Amiiim,oglvcoside ‘1(1(5(1

‘as

Agent)

day’s, and

SUrgery

40.3

per-

21 percemit 15.9

(Joseph

percent

LoCicero)

-

CARDIAC

SURGERY

POSTOPERATIVE

DOSING

PERCENT 60 50 40 30 20 10 0 NONE

I

2

3

TIMING CABG Fm;umom: 2.

for

more

three

than

I)ostolperative ageal resection

period days,

30

three

days.

Other

for

timing

more

than

two)

cases

of

twO) days

in trauma three

Nearly

percent

for

In

dosimig

car(liac

(hiring

6 percent

days

for

days,

amid

trauma,

18.9

most

postoperative

one

was (15.4

percent),

three

percent

(19.2 and

LIIPEDIATRIC

folr

and

(11W

the

amitibiotics next

in

decade,

studies

1977,

the

having

a

or cefazolin

percent

major

1979, DmScuSSIoN

reports,

one

patients (Iii

pumlmlionary

resectiolns

GENERAL PREOP

THORACIC & INTRAOP

SURGERY DOSING

PERCENT 60

vs

He found

18.7 made

evaluated

211

in wound

infection

(27

vs 14 Percent).

of

Likewise, evaluating

Here,

however,

was

there

with an infectioln group vs 19 percent lIves and colleagues, showing (18

a miiajo)r

This

clearly for

rate

in in differ-

vs 5 percemit)

difference

amitil)iotics

in

prospectively-studied imifections).

significant

1)roII)hylactic

al,

colnclusiomis

rates

but

due

et

percent

patients

impressive

a 50 vs 19

similar

patients.

1981,

receive

mostly

Truesdale

in 57

77

to)

respectively

However,

ence

use

the

controlled

randomized resection

rate

difference

et al6

During (If

prospectively

prophylaxis.

randomized

sepsis

40

al

nearly a significamit difference (If 28 percent imi the placebo) the amitil)iotic group. Finally,

less 50#{149}

no

(7.20

Cameron 171

surgery.2’3

pulmonary

sepsis.

found

the 1960s prophylactic

(If

of a variety

infection

to) pulmonary

classic

et

placebo

(11.8

use

debate.

Kvale

percent),

froni

the

cardiothoracic

patients

mione

procedures over

interpretation

fueled

In

heart

controlversy

percent).

percent).

Two

open

(Ifl

imiitiated

gave

surgeons

(43.8 day

no

esopha lolnger

than

>7

surgery.

gave

longer

7

(DAYS)

VALVE

Surgeons performiiing to give antibiotics folr

38.3

percent

antibiotics

days.

antibiotics. tended

time:

(If

PoIstoII)eratio’

5

with

a

imi pulmonary established

lulncardiac

the thoracic

surgery. 30

FoIr open

heart

sumrgery;

there

the need for prophylactic of solid scientific evidence.

20 10

retrospective

repolrts

all

Was

antibiotics A series

on

emphasized

mnom’e

agreemnent

despite a lack of uncontrolled the

use

of pro-

phylactic TIMING Fmctnm: thoracic

3. Preoperative surgery

i11(l

imitraolpvrative

dosimig

duirimig

gemieral

antibiotics to) prevent potential endocarditiS.I4mm However, in 1968, Goodman et al,ma during a prospective evaluation of a variety of doses of antibiotics,

quickly

terminated

the

CHEST

placelx

arm

I 98 I 3 I SEPTEMBER,

Downloaded from chestjournal.chestpubs.org by guest on December 30, 2011 © 1990 American College of Chest Physicians

following

1990

721

GENERAL

THORACIC

SURGERY

POSTOPERATIVE

DOSING

PERCENT 50

40 30 20 10

0

NONE

1

2

3

TIMING

Fmo;tIoF:

4.

two)

fatal

episodes

also

found

no

difference

the

length

(If

antibioltic

in prophylactic

have

1)een

and

co)lleaguesm3.m5

had

before,

suggested

that

organisms.

Fekety,

short

A number

equivalency

Less

viewed

infection

and

et aim2

rates.

be

resistant

subsequently

reported

for

cephalothin,

This

might olf

antibiotics

was

given

and traumma. Neugebauer tube

antibiotics

Goldmami

prophylaxis

gentamicin,

cef-

om#{176}#{176}m9

attention

procedures conflicting.

and

development

ofsttmdies

and

triaxone,

effirts sumrgery length

of prophyla.xis

less

methicihlin,

then,

as Goodman in

many

(If

He upon

in cardiac appropriate

Conte

courses

with

thoracic

of antibiotics.

difference

efficaciolus

general

based

Since

demnonstrated,

no

including

rate

regimens.

choice

during

to mmor

demonstrated monary sepsis

surgical

Here the data were et al5’ retrospectively

thoracostomies were

tholracic

concluding

of little

benefit.

prospectively in a small

also re-

prophylactic

Later,

Grolven

et al2m

a lower incidence of pulseries of patients with tube

thoracostomies. In

recent

years,

more controllable

surgical

Cruse

patient. correctable

preoperative

in

identified

gain. 722

bathing,

stay,

additional

such

emphasis

has

caimses

outlined

causes

preoperative

patients

TRAUMA

surgery

Additional incentives

factors, further

to

infections.

A report

1986

of

that

percent

by

496

added

extra

expenses.

cautio)ned easily

these

aimed which

at preventioln would lead

“having

an infection

concluding,

should to the

to

interest

ofthe

over

all of the

additional be argued

cost that

was only methods

cost less erroneous

than this amount conclusion that

than

preventing

of prophylactic

our

duties

If a conflict of

be in the

it.”

He

antibiotics

by

the patient our best efforts to his or her health, but we are also

perform

considerations. interest

could

infection

owe

or restore

obliged

in

comment,

distributed

is cheaper

concept

“We

preserve

were

study, the therefore,

the

$8,000

statistics of the

a 3

compli-

over

in an editorial cost

in

with

wound and

compelling

patients

(If

the new surgical

patients

days,

If the

in the It could,

are

Dries#{176} showed

a postoperative

hospital

patients $213.

and bypass

Robicsek,24

that

reaffirmed

Nelson

rate, 16.7

reinterpreted.

3 percent

economic, cardiothoracic

coronary

infection

cation

namely curtail

our

patients’

cost

with

due

emerges health

provider,

economical

between and

our place

the

the

best

economic

is at our patients’

side.”

at manipulating

tially

E1

ESOPHAGEAL

endocarditis.

in infection

the

by

their

the

dosimig

of pneumolcoccal

Experiments

more

Postoperative

antibiotic research directed at defining the

of prolphylaxis

-

PULMONARY

in

factors

as postoperative

directed in the

mamiy olfthese 1975.

preoperative

etc.

been

of infection

poten-

These

included

shaving,

Conklin

and

in coronary

transfusions

redtmction

coIlleaguesm artery

and

In

this

American

survey,

the

College

(If

prophylactic major of

antibiotics

cardiotholracic

antibiotics,

tients,

bypass

still

experience ducted

(If

remain

are

to identify,

Prophylactic

local but

Antibiotics

The

choice

penicillin-allergic length

choice set

that

in today’s

procedures.

practice. not

agrees

a requirement

and of

the

of

clearly

for

dosages,

a matter

and

membership

surgical particularly

timing

weight

surgical Cardiology

based,

This the

in Cardiothoracic

pa-

of prophylaxis in

survey

trends Surgery

Downloaded from chestjournal.chestpubs.org by guest on December 30, 2011 © 1990 American College of Chest Physicians

part,

was

on

con-

of prophylac(Joseph

LoCicem)

usage

in cardiac

Local personal

differences experience

tic antibiotic

procedures. bility and specific

and

noncardiac

surgical

in microbial will continue

13

susceptito) dictate

REFERENCES BR,

ed.

Antimicrobial

JC,

infection

Nelsoln

RM.

The

Philadelphia:

incidence

J Tholrac

in thoracotomnies.

Saunders,

1972;

of

hospital

R, Litwak (If

Antimicrob

Agents

4 Kvale

Pulmonary

Cardiolva.sc

Surg

Ehrenkranz

NJ.

1967;

54:

vs

R,

diovasc

JD,

10 Stein

PD,

MG.

RM.

CB,

Spray

DE,

WB.

S.

Baker

18

prophylactic

Goldsmith

El.

Thorac

SF, Arch

Peterson

Stmrg 1964;

CA,

Sanders

heart

in open

Car-

20

89:970-74

surgery.

Effective Arch

Infectioln Surg JS,

Dexter

L. The

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I 98 I 3 I SEPTEMBER,

Downloaded from chestjournal.chestpubs.org by guest on December 30, 2011 © 1990 American College of Chest Physicians

1990

723

all were

diagnosed

Thoracic

Soiciety

woimen.

with

bronchial

criteria.’

Their

age

The

range

asthma

group

was

according

consisted

to American

of320

20 to 75 years,

with

men

and

a median

240

age

of

49 years. Occupational criteria:

asthma

2) exposure

and

agent;

We had

only

asthma

patients

was

metallic

quently

n(irmal

Common

3-human

clinical

metastatic

Hoiwever,

chorioinic

bilateral

Second,

Our

hemothorax otherwise

patient

despite

he

evaluation

two

or postpartum noirmal

to that

especially

in female

Medical

four

women-

in

and

diagnosis

of OA.

handling

chemicals

products

in

patients

(14.7

five

Occupain

1 1 patients

in

Third-World

in industrialized

this

study

woirk

tests

which

developed

percent);

and

countries developed

15

(32.4

of low

countries,24

patients.

at

and

country,

was

and

at

not

immunoilogic most

rate

or

tests,

likely

to be

of OA,

is scarcely

confirmed

home,

by

by

this

study

does

attempt

with

in a technically

described

pulmonary

hromchopulmonary

associated

less

in the

literature.

NightingaleSyabbalo,

MB.,

Ch.B.,

OA,

to)

as well

indtmstrialized

Ph.D.,

Umtata

ef-

dehiver;

Umtata,

FCC.?,

Chest

Transkei,

Hospital,

South

Africa

REFERENCES

and

M.D.;

M.D.,

FCC.?;

A. Campbell, A. Sahn,

MI).;

M.D.,

and

FCC.?,

of South

Carolina, Charleston

Reprint requests: Dr Sudduth, I)epartinent Cart’ Medicine, Medical University of South Avenue, Charleston, SC 29425

employment

metastatic

Sudduth,

Strange,

University

OA tests

tumor

pleural

pregnancy;

Berry

men

the

foir spommtaneous

C. David

Steven

for

reported

is with

for metastases.3#{176}

Charlie

percent)-30

agricultural

less

compared

massive

woman,

as a cause

5) change

impor-

First,

carcinomatous

considered

an apparently

negative

demonstrates

complicate

pregnant

simoul(l

and

and

off work;

is

technically

identify occupations as the prevalence

with

presentatioin

choriocarcinoma.

may

in any

chorioicarcimioma

cough,

appreciated

concerning

hemothoraces

fusion.2

involvement

inducing

rate

in

function

subse-

of

to) the

OA

provocation

level.

of pulmonary hemoiptysis,

commonly

oax’ points

with

gonadutroipin

include

a less

nontraumatic clinical

cyclophosphamide,

manifestations

choiriocarcinoma

embohi. tant

and

(5.9

products

3) symptoms

exposure

of symptoms.

criteria to

foillowing

employment;

timber by-products in three patients (8.8 percent). The central conclusion of this study is that the prevalence

Although actinomycin-D

due

(44. 1 percent);

percent);

methotrexate,

clinical

of the

at work;

after when

to persistence

34 patients the

agent

hoiurs

basis

commencing

of symptoms

due

who fulfilled

1

a few

4) improvement

on the

before

inducing

dyspnea

ofemployment

tional

diagnoised

of asthma

to a recognized

wheezing

FIGURE

was

1) noi history

of Pulmonary/Critical Carolina, 171 Ashley

1 American Thoracic Society. Definition and classification of chronic iiro)nchitis, asthma and pulmonary emphysema. Am Rev Respir Dis 1986; 136:225-44 2 Brooks SM. Occupational asthma. In: Weiss EB, et al, eds. Broinchial asthma. Boston: Little, Brown and Coi, 1985; 461-93 3 Kothayashi S. Occupational asthma in Japan. In: Proceedings of the VIIIth Internatiomnal Congress oin Allergology. Amsterdam: Excerpta, 1974; 124-32 4 Pauhi G, Bessot JC, Dietmann-Moilard A. L’asthma prcofessional: investigation et principale etiologies. Bull Eur Physiopathol Respir 1986; 22:399-425

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1 DeFrance JH, Blewett JH Jr. Ricci A, Pattersomi LT. Massive hemothoirax: twO) unusual cases. Chest 1974; 66:82-84 2 Evans KT, Cockshott WP, Hendrickse P de V. Pulmoinarv chammges in mahignanmt troiphoblastic disease. Br J Radiol 1965; 38:412-16 3 Driscohl SG. Choriocarcinoima: an “incidental finding” within a term placenta. Obstet Gynecol 21:96-101 4 Kulkarni R, Lister UG. Metastatic chorioicarcinoma coexisting with full term viable pregnancy. Postgrad Med J 1985; 61:101314

Errata The

editors

M PH

Comparative

Study

Fibrosis

and

page

1315,

“They

had

members

Occupational Country

Asthma

force

little (OA)

less

information and

developed

on

occupations

Third-Woirid

countries,

the

prevalence

rate

most

likely

to be associated

there

of occtmpational with

is very asthma

this

type

We

teaching

.

attended

to) 580

hospital

adult

respiratory

asthmatic clinic

patients in

Lusaka,

at

by

“attained

1990; at the

entered

the the

members by those

of the who

with

had

“A Cystic

97:1310-16).

sentence

dependents

never

article,

of Adults

following and

L. Shepherd, in his

same

On

appeared: rates

as had

was

at least

occupational

work

status

force

comparison ever

group.”

entered

It

the work

.“

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paragraph

on

agrees

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the group

had

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read:

Surgery”

major regularly

.

membership of

asthma. university

have

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comparison who

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Peers”

column, and

the

to Steven

that

Psychosocial

Healthy

married

In the article

ii) the Editor: 1mmtevhmmically

Their

as that

should

to apologize error

of the

by those

as good

wish

right-hand of

attained

in a Developing

of Chest

for a typographical

,

“Proiphylactic 1990; page

of the that

722

should

American

prophylactic

cardiothoracic

Antibiotic

98:719-23), read:

first

“In

College

antibiotics surgical

Usage

the

this

of Chest are

in Cardiothoracic sentence survey,

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Physicians

a requirement

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surgical clearly in

today’s

procedtmres.”

our

Zambia;

528

Communications

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to the Editor

Prophylactic antibiotic usage in cardiothoracic surgery. J LoCicero, 3rd Chest 1990;98; 719-723 DOI 10.1378/chest.98.3.719 This information is current as of December 30, 2011 Updated Information & Services Updated Information and services can be found at: http://chestjournal.chestpubs.org/content/98/3/719.citation Cited Bys This article has been cited by 4 HighWire-hosted articles: http://chestjournal.chestpubs.org/content/98/3/719.citation#related-urls Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.chestpubs.org/site/misc/reprints.xhtml Reprints Information about ordering reprints can be found online: http://www.chestpubs.org/site/misc/reprints.xhtml Citation Alerts Receive free e-mail alerts when new articles cite this article. To sign up, select the "Services" link to the right of the online article. Images in PowerPoint format Figures that appear in CHEST articles can be downloaded for teaching purposes in PowerPoint slide format. See any online figure for directions.

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