This paper is only available as a PDF. To read, Please Download here.
Abstract
Background. Postoperative pneumonia (PP) is a major complication that has been linked to microaspiration
of pathogens originating in the gastrointestinal tract. This prospective study was
performed to define the role of gastric bacterial aspiration in the development of
PP.
Methods. Informed consent was obtained before operations from 140 veterans scheduled for major
elective procedures requiring nasogastric tubes, and cultures were obtained of the
gastric contents and sputum twice daily after operation.
Results. PP developed in 26 (18.6%) of 140 patients. The patients who had PP did not differ
from those with no pneumonia after operation except for a history of chronic obstructive
pulmonary disease, which was found in 38.5% of those with PP compared with 20% of
patients with no pneumonia (p < 0.05). Morbidity was increased in association with
PP, because length of stay in the surgical intensive care unit (6.2 vs 2.6 days),
days intubated (2.7 vs 0.6), total postoperative days (15.3 vs 8.4), and mortality
rates (19.2% vs 1.7%) were greater than in patients with no pneumonia. Gastric pathogens
were present on entry in 38% of patients, and 32% of these had PP compared with 13%
whose initial gastric cultures were sterile (p = 0.01). Colonization of sputum for
greater than 24 hours with gastric pathogens occurred in 28% of patients. These patients
had a 40% incidence of PP compared with 12% in patients without such evidence of microaspiration
(p < 0.01).
Conclusions. PP is a morbid postoperative complication associated with not only chronic obstructive
pulmonary disease but also the presence of gastric bacteria during operation and transmission
of gastric bacteria to the pulmonary tree after operation.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Nosocomial bacterial pneumonias.in: Semin Respir Infect. 4. 1989: 245-252
- The nationwide nosocomial infection rate: a new need for vital statistics.Am J Epidemiol. 1985; 121: 159-167
- Risk factors for postoperative pneumonia.Ana J Med. 1981; 70: 637-680
- Stomach as a source of bacteria colonizing the respiratory tract during artificial ventilation.Lancet. 1978; 11: 968-969
- Colonization of the gastric content in critically ill patients.Crit Care Med. 1982; 10: 444-447
- Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonization of the airway.Lancet. 1982; 1: 242-245
- Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids and histamine type 2 blockers: the rote of gastric colonization.N Engl J Med. 1987; 317: 1376-1382
- Application of a biotyping system and DNA restriction fragment analysis to the study of Serratia marcescens from hospitalized patients.Diagn Microbiol Infect Dis. 1993; 16: 1-7
- Restriction endonuclease analysis of Staphylococcus aureus plasmid DNA from three continents.Eur J Clin Microbiol Infect Dis. 1992; 11: 4-8
- Application of restriction endonuclease analysis of chromosomal DNA in the study of Staphylococcus aureus colonization in continuous ambulatory peritoneal dialysis patients.Diagn Microbiol Infect Dis. 1992; 15: 195-199
- APACHE II: a severity of disease classification.Crit Care Med. 1985; 13: 818-829
- Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation.Am Rev Respir Dis. 1986; 133: 792-796
- Risk factors for postoperative pneumonia: the importance of protein depletion.Ann Surg. 1988; 208: 209-214
- Multivariate analysis of risk factors for pneumonia following cardiac transplantation.Transplantation. 1988; 6: 860-865
- Preoperative assessment of the likelihood of infection of the lower respiratory tract after cardiac Surgery.Thorac Cardiovasc Surg. 1991; 39: 85-88
- The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients.J Trauma. 1987; 27: 357-364
Article info
Footnotes
☆Supported by Veterans Administration Merit Review Research.
☆☆Presented at the Fiftieth Annual Meeting of the Central Surgical Association, Cincinnati, Ohio, March 4–6, 1993.
Identification
Copyright
© 1993 Published by Elsevier Inc.
