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Nosocomial Infection After Lung Surgery^*

Incidence and Risk Factors

^* From the Infectious Diseases Unit, Department of Internal Medicine (Drs. Nan, Fernández-Ayala, González-Macías, and M.C. Fariñas), Division of Preventive Medicine (Dr. C. Fariñas), and Department of Thoracic Surgery (Drs. Mons and Ortega), Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.

Correspondence to: M. Carmen Fariñas, MD, PhD, Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, E-39008 Santander, Spain; e-mail: mirfac{at}humv.es

Study objectives: To assess the incidence and risk factors for nosocomial infection after lung surgery.

Design: Prospective cohort study.

Setting: Service of thoracic surgery of an acute-care teaching hospital in Santander, Spain.

Patients: Between June 1, 1999, and January 31, 2001, all consecutive patients undergoing lung surgery were prospectively followed up for 1 month after discharge from the hospital to assess the development of nosocomial infection, the primary outcome of the study.

Interventions: During the hospitalization period, patients were visited on a daily basis. Postdischarge surveillance was based on visits to the surgeon.

Measurements and results: We studied 295 patients (84% men; mean age, 60.9 years), 89% of whom underwent resection operations. Ninety episodes of nosocomial infection were diagnosed in 76 patients, including pneumonia (n = 10), lower respiratory tract infection (n = 47), wound infection (n = 16; one third were detected after hospital discharge), urinary tract infection (n = 9), and bacteremia (n = 8; three fourths were catheter-related bacteremia). Twenty patients had severe infections (pneumonia or empyema), with a mortality rate of 60%. COPD (adjusted odds ratio [OR], 2.70; 95% confidence interval [CI], 1.52 to 4.84), duration of surgery with an increased risk for each additional minute (Mantel-Haenzel ² test for trend, p = 0.037), and ICU admission (OR, 3.69; 95% CI, 1.94 to 7.06) were independent risk factors for nosocomial infection. The use of an epidural catheter was a protective factor (OR, 0.45; 95% CI, 0.22 to 0.95). There were no differences according to the use of amoxicillin/clavulanate or cefotaxime for surgical prophylaxis.

Conclusions: Nosocomial infections are common after lung surgery. One third of wound infections were detected after hospital discharge. The profile of a high-risk patient includes COPD as underlying disease, prolonged operative time, and postoperative ICU admission.

Key Words: lung resection • nosocomial infection • risk factors • thoracic surgery

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