Chest
Clinical InvestigationsNosocomial Infection After Lung Surgery: Incidence and Risk Factors
Section snippets
Study Location and Patients
The study was conducted at a university-affiliated teaching hospital, Marqués de Valdecilla (1,100 beds), in Santander, Spain. The Division of Thoracic Surgery includes four staff surgeons and one resident. Approximately 400 thoracic procedures are performed annually, 150 of which are lung resections. During a 19-month period (June 1999 to January 2001), all patients undergoing pulmonary surgery were potentially eligible for this investigation. Patients < 14 years of age and patients undergoing
Study Design and Data Collection
Patients were visited on a daily basis to collect all pertinent data, which was recorded on a standardized data collection form. The following characteristics were prospectively recorded by one of the investigators: age; sex; body mass index; smoking history; alcohol consumption; presence of COPD; diabetes mellitus; hypoalbuminemia (serum albumin level < 3 g/L); anemia (hemoglobin < 12 g/dL); renal failure (serum creatinine level > 2 mg/dL); preoperative American Society of Anesthesiologists
Statistical Analysis
For each category of potential risk factors for infection, the incidence of nosocomial infection was calculated by dividing the number of events by the number of patients in each category. Relative risks (RRs) and their 95% confidence intervals (CIs) were calculated. All tests of significance were two tailed, and p values ≤ 0.05 were considered to indicate statistical significance. Multiple logistic regression analysis was performed to identify variables that were significantly related to the
Patients
A total of 295 consecutive patients undergoing lung surgery were prospectively evaluated. The mean age of the patients was 60.9 years (range, 14 to 83 years); 247 patients were men. The mean (± SD) length of preoperative stay was 3.0 ± 3.5 days. The surgical procedures performed included pneumonectomy (n = 78), lobectomy (n = 110), lung-sparing procedures (n = 76), and other surgical procedures (n = 31; including chest wall resections). Lung cancer was diagnosed in 231 patients, and benign
Incidence of Nosocomial Infection
Nosocomial infections developed in 76 patients (25.8%). Sixty-four patients presented a single infection episode, 10 patients had two infection episodes, and 2 patients had three episodes, a total of 90 nosocomial infections. These included respiratory infection (n = 57; pneumonia [n = 10], lower respiratory tract infection [n = 47]), wound infection (n = 16), urinary tract infection (n = 9), and bacteremia (n = 8; three fourths were catheter-related bloodstream infection). Of the 16 cases of
Antibiotic Prophylaxis
A total of 283 patients received perioperative antibiotic prophylaxis: cefotaxime (n = 96), amoxicillin/clavulanate (n = 174), and vancomycin or teicoplanin due to penicillin allergy (n = 13). There were no statistically significant differences in the risk of infections between the two first regimens (RR, 1.41; 95% CI, 0.9 to 2.3).
Risk Factors
With regard to preoperative variables (Table 2), COPD (OR, 2.70; 95% CI, 1.5 to 4.8), FEV1 < 1,500 mL (OR, 2.46; 95% CI, 1.1 to 6.0), ASA physical status > 3 (OR, 1.82; 95% CI, 1.1 to 3.3), and anemia (serum hemoglobin < 12 g/dL) [OR, 1.90; 95% CI, 1.1 to 3.5] were risk factors for nosocomial infection. Other comorbidities (eg, chronic heart failure), body mass index, hypoalbuminemia, and renal failure as well as the length of preoperative stay were not identified as risk factors for the
Discussion
This study shows that nosocomial infections are common among patients undergoing lung surgery, with a rate of 25.8%. As far as we are aware, this is the first epidemiologic study of nosocomial infections in the subset of patients undergoing pulmonary surgery. Previous studies211 were comparative studies of antibiotic prophylactic regimens or studies on mortality. We included all types of infections, varying from respiratory or wound infections developing in patients undergoing major operations,
Acknowledgement
We thank Marta Pulido, MD, for editorial assistance.
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
Dr. Nan received a fellowship from the “Fundación Marqués de Valdecilla,” Santander, Spain.