Staphylococcal Pneumonitis in the Postoperative Patient

¹ Division of Medicine, The Mason Clinic.
² Resident, Internal Medicine, Virginia Mason Hospital.
³ Division of Surgery, The Mason Clinic.

Thirten adult postoperative patients afflicted with staphylococcal pneumonitis are reviewed. The surgical procedures included intracranial, facial, thoracic, cardiac, abdominal, urologic, and gynecologic operations. The onset of the disease occurred in the first three postoperative days in 10 of the 13 instances. When a postoperative patient manifests signs of severe resipratory insufficiency, incongruously low temperature, prolonged expiratory phase of respirations despite gross tachypnea and hyperpnea, purulent bloody sputum, and leukocytosis, staphylococcal pneumonitis must be suspected. This suspicion must be held despite singular lack of confirmatory roentgenographic changes in the lungs. A gram-stained smear of sputum demonstrating many gram positive coccal forms adds enough diagnostic evidence to initiate vigorous, aggressive therapy without delay. In view of the probability that the infecting staphylococcus will prove resistant to usual antibiotics, we advocate the prompt use of Vancomycin or Ristocetin intravenously. Because of gross respiratory insufficiency of obstructive type commonly present in postoperative patients with staphylococcal pneumonitis, inhaled nebulized bronchodilators, intermittent positive pressure breathing devices, and tracheostomy when indicated, have proved their value.