Bronchoalveolar lavage in the prediction of post-thoracotomy chest infection

A prospective study was carried out on 75 patients undergoing pulmonary surgery to determine the relationship between perioperative lung flora and postoperative infections. Seventy-five patients having pleurectomy or pneumonectomy received cefuroxime prophylaxis; 1.5 g i.v. at induction followed by 6 further doses of 0.75 g i.v. over 48 h. Bronchoalveolar lavage samples were taken perioperatively via bronchoscopy in pleurectomy patients and from excised lung in patients undergoing lung resection. Patients were monitored for development of chest infection during the first 10 days after operation. Bacterial pathogens were cultured from 12 out of 54 lavage samples. The most common pathogen was Haemophilus influenzae and all the organisms were sensitive to cefuroxime. Eight patients (10.7%) developed postoperative chest infection. The likelihood of developing postoperative chest infection was 42% (5 out of 12 patients) in those patients whose lavage culture was positive for bacterial pathogens compared to 4.8% (2 out of 42 patients) for those whose culture was negative (chi 2 test, p less than 0.001). These results suggest that the culturing of bacterial pathogens from lavage samples from resected lung is a significant predictor of postoperative chest infection in patients undergoing pulmonary resection.