title: Perioperative Microbiologic Monitoring of Sputum on Postoperative Day One as a Predictor of Pneumonia After Hepatectomy.
abstract: BACKGROUND
  The purpose of this study was to retrospectively evaluate microbial examination of sputum on postoperative day one (POD1) and to determine risk factors for postoperative pneumonia (POP) after hepatectomy.
  
  
  METHODS
  Two hundred ninety-four patients who expectorated sputum on POD1 after hepatectomy between 2003 and 2014 were investigated. Sputum samples were submitted for microbial examination. Risk factors for POP were identified using multivariable analysis.
  
  
  RESULTS
  One hundred fifty-eight (53.7%) of 294 patients had bacteria in their sputum on POD1. POP was observed in 24 (8.2%) patients, with increased mortality in the patients with POP (0.74 vs 12.5%, p < 0.01). Multivariate analysis demonstrated that a Brinkman index of >400 and bacteria in sputum on POD1 were independent risk factors for POP. Bacterial homology in sputum obtained on POD1 and onset day of POP was found in 13 of the 24 (54.2%) patients with POP. In particular, in 13 patients with POP caused by methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa, homology was confirmed in 9 patients (69.2%).
  
  
  CONCLUSIONS
  A Brinkman index ≥400 and bacteria in sputum on POD1 increased the risk of POP. Presence of bacteria in sputum on POD1 may be useful in determining early treatment against POP after hepatectomy.
authors.affiliation: Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan, kazusaka@yamaguchi-u.ac.jp.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Takao
authors.initials: T
authors.lastname: Tamesa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tokuhisa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsukuma
authors.forename: Yukio
authors.initials: Y
authors.lastname: Tokumitsu
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Maeda
authors.forename: Shigeru
authors.initials: S
authors.lastname: Takeda
authors.forename: Tomio
authors.initials: T
authors.lastname: Ueno
authors.forename: Shigeru
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Yoshino
authors.forename: Shoichi
authors.initials: S
authors.lastname: Hazama
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano
authors.forename: Masaaki
authors.initials: M
authors.lastname: Oka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology*