title: Nosocomial infection after lung surgery: incidence and risk factors.
abstract: OBJECTIVE
  To assess the incidence and risk factors for nosocomial infection after lung surgery.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Service of thoracic surgery of an acute-care teaching hospital in Santander, Spain.
  
  
  METHODS
  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.
  
  
  METHODS
  During the hospitalization period, patients were visited on a daily basis. Postdischarge surveillance was based on visits to the surgeon.
  
  
  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 chi(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.
authors.affiliation: Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, E-39008 Santander, Spain.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Nan
authors.forename: Marta
authors.initials: M
authors.lastname: Fernández-Ayala
authors.forename: Concepción
authors.initials: C
authors.lastname: Fariñas-Alvarez
authors.forename: Roberto
authors.initials: R
authors.lastname: Mons
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Ortega
authors.forename: Jesús
authors.initials: J
authors.lastname: González-Macías
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Fariñas
mesh_terms: D001424:Bacterial Infections / Q000145:classification / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D012141:Respiratory Tract Infections / Q000453:epidemiology; D012307:Risk Factors; D013030:Spain; D013530:Surgical Wound Infection / Q000453:epidemiology