title: Bronchial colonization and complications after lung cancer surgery.
abstract: OBJECTIVE
  Infectious complications occur following pulmonary resections preceded or not by induction chemoradiotherapy. We aimed to investigate whether bacterial colonization of the bronchial tree at the time of surgery was associated with postoperative complications.
  
  
  METHODS
  A retrospective analysis of all patients who underwent open anatomical pulmonary resections for malignancies at a single center was performed. Demographical data of the included patients, intraoperative data, and data on the postoperative course of patients were collected. Outcome of patients with a positive intraoperative bronchial culture was compared to patients with a negative bronchial culture. Relations between the presence of potential bacterial pathogens in the bronchial tree and other possible risk factors for the development of postoperative infectious and non-infectious complications, were analyzed using uni- and multivariate analysis.
  
  
  RESULTS
  Between January 2010 and January 2012, a total of 121 consecutive patients underwent open anatomical pulmonary resections for malignancy, of whom 45 were preceded by induction chemoradiotherapy and 5 by induction chemotherapy. Intraoperative bronchial cultures were taken from 58 patients (48 %). Patients with a positive bronchial culture developed significantly more infectious (88 % vs. 20 %, p < 0.001) and non-infectious complications (63 % vs. 12 %, p = 0.001). Positive intraoperative bronchial cultures showed the strongest association with the development of infectious and non-infectious postoperative complications (OR 24.8 and 12.2, respectively). After multivariate analysis, only BMI less than 20 kg/m(2) and the presence of a positive intraoperative bronchial culture were found to be independent risk factors for the development of infectious complications. Chemoradiotherapy was not associated with postoperative complications in the present study.
  
  
  CONCLUSIONS
  Bacterial colonization of the bronchial tree assessed intraoperatively, appears to be associated with higher rates of infectious and non-infectious complications after pulmonary resection. Whether early starting of appropriate antibiotics based on intraoperative-taken culture findings will reduce the infectious complication rate in a subcategory of patients needs to be investigated.
authors.affiliation: Department of Surgery, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3430 VB, Nieuwegein, The Netherlands. j.oor@antoniusziekenhuis.nl.
authors.forename: Jelmer E
authors.initials: JE
authors.lastname: Oor
authors.affiliation: Department of Pulmonary Diseases, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Johannes M A
authors.initials: JM
authors.lastname: Daniels
authors.affiliation: Department of Clinical Microbiology and Infection Control, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Yvette J
authors.initials: YJ
authors.lastname: Debets-Ossenkopp
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Elly S M
authors.initials: ES
authors.lastname: de Lange-de Klerk
authors.affiliation: Department of Surgery, MCH/Bronovo/A12 Oncology Center, 2509 JH, The Hague, The Netherlands.
authors.forename: Jan W A
authors.initials: JW
authors.lastname: Oosterhuis
authors.affiliation: Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.|Department of Cardio-Thoracic Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Chris
authors.initials: C
authors.lastname: Dickhoff
authors.affiliation: Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
authors.forename: Koen J
authors.initials: KJ
authors.lastname: Hartemink
mesh_terms: D000328:Adult; D000368:Aged; D001980:Bronchi / Q000382:microbiology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Antibiotics; Bronchial culture; NSCLC; Postoperative complications; Thoracic surgery