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

^* 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{at}ub.edu

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.

Key Words: bronchial colonization • lung cancer • nosocomial pneumonia • postoperative respiratory infection

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