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
following role
1967; Schaffner
Infection examination
after
Am
of
nature
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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
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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
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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
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members by those
of the who
with
had
“A Cystic
97:1310-16).
sentence
dependents
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article,
of Adults
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L. Shepherd, in his
same
On
appeared: rates
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status
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membership of
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to Steven
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In the article
ii) the Editor: 1mmtevhmmically
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as that
should
to apologize error
of the
by those
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wish
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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
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College
antibiotics surgical
Usage
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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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