Amoxicillin-clavulanic acid resistance in the first postoperative pneumonia after cardiac surgery: Risk factors and outcomes from a 10-year cohort analysis

Kovacs, D; Rekik, M; Lavollay, M; Compain, F; Boumezrag, CB; Zannis, K; Caussin, C; Teil, E; Bouabdallah, K; Blayau, C; Wicky, PH; Allou, N; Beaussier, M; Desmard, M; Tran-Dinh, A; Heart Team IMM study group

doi:10.1016/j.accpm.2025.101622

Cardiothoracic & vascular anesthesia

Amoxicillin-clavulanic acid resistance in the first postoperative pneumonia after cardiac surgery: Risk factors and outcomes from a 10-year cohort analysis

Anaesth Crit Care Pain MedPublished 26 Sep 2025Retrospective cohort study

Main finding · ICU LOSResultAdjusted mean difference 7.0 days 95% CI 2.8–11.7

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Authors' conclusion

AMC-R POP represented half of the POP cases occurring within 7 days of CS and was associated with longer ICU length of stay.

Study context

Population: Patients who underwent cardiac surgery between January 2013 and December 2023 and developed microbiologically documented postoperative pneumonia (POP) within 7 postoperative dayscases of POP
Participants: 352 patients

Exposure: AMC-R POP vs POP
AMC-R POPn = 186
Outcome: ICU LOS

Methodological detailssingle-centre

Single-centre

Main finding

As reported in the abstract

Adjusted mean difference

7.0 days

95% CI 2.8–11.7

AMC-R POP vs AMC-susceptible POP

adjusted mean difference 7.0 days (95% CI 2.8–11.7)

Observational data: associations, not effects.

Further findings

Outcome		HR (95% CI)
90-day survival (time-to-event analysis) · 90 daysAMC-R POP vs AMC-susceptible POP · lower survival with AMC-R POP	0.20.5125	0.50 (0.27–0.93)
	0.20.5125Hazard ratio (log scale)

Independent risk factors of AMC-R POP

	← Lower odds ←→ Higher odds →	aOR (95% CI)
Redo surgery	0.10.31310	3.74 (1.73–8.84)
Multiple major procedures	0.10.31310	1.94 (1.18–3.21)
SAPS II ≥ 35 at ICU admission	0.10.31310	2.42 (1.50–3.91)
	0.10.31310Adjusted odds ratio (log scale)

Outcome	AMC-R POP
Prevalence of AMC-R among POP	53%

Prevalence of AMC-R among POP — AmpC-producing Enterobacterales: 25.6%
Prevalence of AMC-R among POP — Pseudomonas aeruginosa: 14.6%

Original publication

Amoxicillin-clavulanic acid resistance in the first postoperative pneumonia after cardiac surgery: Risk factors and outcomes from a 10-year cohort analysis. Anaesth Crit Care Pain Med. Published 26 September 2025. doi:10.1016/j.accpm.2025.101622

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