OGC P61 Audit of diagnosis and treatment of early pneumonia after elective oesophagogastric resections

Abstract

Abstract Background Respiratory complications after oesophagogastric (OG) cancer surgery are common and present as some of the most severe. Post-operative respiratory complications reduce disease free and overall survival. Incorrect use of antibiotics can have negative outcomes. Are the diagnosis criteria clear and do such patients receive the correct management? This audit assesses diagnoses of pneumonia against the US Centers for Disease Control (CDC) criteria and antibiotic choice against National Institute for Health and Care Excellence (NICE) guidelines in a regional OG cancer surgery centre (which may be replicated in many other OG centres). Methods We examined records of 109 patients who underwent elective OG surgery at University College Hospital London between July 2021 and June 2022. The post-operative period was defined as 7 days from the initial operation. Results 30.2% of all patients were treated with antibiotics for pneumonia in the post-operative period. 42.4% of these patients had a sputum sample taken at the time of clinical suspicion of pneumonia, and 42.8% of these grew one or more relevant organisms. 69.7% of treated patients were prescribed a NICE-approved antibiotic. 17.4% of all patients developed pneumonia per the US CDC criteria and these patients had a longer stay in ICU (10.6 days compared to 5.3 days) and hospital (29.4 days compared to 14.3 days) than those who did not. 30-day mortality rate was 0% in this group. Conclusions This audit identified variability in diagnosis and antibiotic prescribing in post-operative pneumoniae. Sputum analysis was used inconsistently to diagnose and guide antibiotic therapies; cultures were often taken after antimicrobials were initiated, with patients treated symptomatically rather than based on microbiology results. Recommendations following this audit comprised; the use of CDC criteria to promote accurate diagnosis in the post-operative period, and regular multidisciplinary review of antibiotic agents prescribed to ensure appropriate targeted treatment.