• Daniel N Nan, Marta Fernández-Ayala, Concepción Fariñas-Alvarez, Roberto Mons, Francisco J Ortega, Jesús González-Macías, and M Carmen Fariñas.
• Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, E-39008 Santander, Spain.
• Chest. 2005 Oct 1;128(4):2647-52.

Study ObjectivesTo assess the incidence and risk factors for nosocomial infection after lung surgery.DesignProspective cohort study.SettingService of thoracic surgery of an acute-care teaching hospital in Santander, Spain.PatientsBetween 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.InterventionsDuring the hospitalization period, patients were visited on a daily basis. Postdischarge surveillance was based on visits to the surgeon.Measurements And ResultsWe 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.ConclusionsNosocomial 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.

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