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Clinical Investigations: SURGERY |

Bronchial Colonization and Postoperative Respiratory Infections in Patients Undergoing Lung Cancer Surgery*

Jose Belda, MD, PhD; Manuela Cavalcanti, MD; Miquel Ferrer, MD, PhD; Mireia Serra, MD; Jorge Puig de la Bellacasa, MD; Emilio Canalis, MD, PhD, FCCP; Antoni Torres, MD, PhD, FCCP
Author and Funding Information

*From the Institut Clínic de Pneumologia i Cirurgia Toràcica (Drs. Belda, Cavalcanti, Ferrer, Serra, Canalis, and Torres), and Servei de Microbiologia (Dr. Puig de la Bellacasa), Hospital Clínic, and Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.

Correspondence to: Antoni Torres, MD, PhD, FCCP, Servei de Pneumologia, Hospital Clínic, Villarroel 170. 08036 Barcelona, Spain; e-mail: atorres@ub.edu



Chest. 2005;128(3):1571-1579. doi:10.1378/chest.128.3.1571
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Study objectives: To evaluate the risk factors associated with postoperative respiratory infection in patients undergoing lung cancer surgery, with special emphasis on the perioperative pattern of airway colonization.

Design: Prospective cohort study.

Setting: Department of Pneumology and Thoracic Surgery of a tertiary hospital.

Patients: Seventy-eight consecutive patients undergoing lung cancer surgery were evaluated. Patients were followed up until hospital discharge or death.

Interventions: Fiberoptic bronchoscopies with bilateral protected specimen brush or bronchial aspirates were performed during anesthesia prior to the initiation of the surgical procedure.

Results: Sixty-five patients (83%) had perioperative bronchial colonization by either potentially pathogenic microorganisms (PPMs) [28 patients, 36%] or nonpotentially pathogenic microorganisms (56 patients, 72%). The 24 patients (31%) with a postoperative respiratory infection (pneumonia, purulent tracheobronchitis, or pleural empyema) had significantly higher perioperative bronchial colonization by PPMs (15 patients [63%] vs 13 patients [24%], p = 0.003) and a higher bacterial index (mean ± SD, 3.6 ± 3.3 vs 0.9 ± 1.4; p = 0.003), compared to patients without infection. The agreement between pathogens found in perioperative evaluation and during postoperative infection was total in 5 patients (21%), partial in 5 patients (21%), and no concordance in 14 patients (58%). In the multivariate analysis, the presence of perioperative airway colonization by a PPM (odds ratio [OR], 6.9; p = 0.001) and a higher postoperative pain score (OR, 4.1; p = 0.014) were independent predictors of postoperative respiratory infection.

Conclusion: Adequate control of postoperative pain, as well as the conditions that potentially cause airway colonization by PPMs, could be beneficial in preventing postoperative respiratory infections after lung cancer surgery.

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