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Oropharyngeal flora and chest infection after upper abdominal surgery
J P Dilworth1, R J White, E M Brown
1Department of Medicine, Westminster Hospital, London.
Abstract:
The oropharyngeal flora was determined before and after operation in 127 patients undergoing upper abdominal surgery. Swabs of the oropharynx were obtained on the day before operation and on the first, third, and fifth postoperative days. Isolation of Haemophilus influenzae, Streptococcus pneumoniae, and coliforms was noted. In the 108 patients with the full series of throat swabs the incidence of oropharyngeal colonisation by H influenzae was 16% and was unchanged after operation. S pneumoniae was present in only 5.6 (six patients) before operation and the incidence fell to 1.9% (two patients). There was a transient rise in coliform colonisation postoperatively. Twenty four patients developed a chest infection. In eight a bacterial cause was established, in six H influenzae and in two S pneumoniae. There was a significant relation between the carriage of H influenzae before operation and development of a chest infection. H influenzae was also found more often in cigarette smokers. The presence of S pneumoniae or coliform organisms before surgery was not related to the development of infection. The high incidence of postoperative chest infection in cigarette smokers appears to be due in part to preoperative colonisation of the oropharynx by H influenzae.
Insights
Preoperative oropharyngeal carriage of Haemophilus influenzae (H. influenzae) significantly increases the risk of postoperative chest infections, particularly in smokers. This finding highlights the importance of identifying H. influenzae colonization before surgery.
Area of Science:
- Medical Microbiology
- Surgical Infections
- Respiratory Medicine
Background:
- Postoperative chest infections are a significant complication of upper abdominal surgery.
- The role of oropharyngeal flora in the development of these infections requires further elucidation.
Purpose of the Study:
- To investigate the changes in oropharyngeal flora following upper abdominal surgery.
- To determine the association between specific bacterial colonization and the incidence of postoperative chest infections.
Main Methods:
- Oropharyngeal swabs were collected from 127 patients before and after upper abdominal surgery.
- Bacterial cultures were analyzed for Haemophilus influenzae, Streptococcus pneumoniae, and coliforms.
- Correlation between preoperative colonization and postoperative infection was assessed.
Main Results:
- Haemophilus influenzae colonization remained unchanged postoperatively (16%).
- Streptococcus pneumoniae incidence decreased, while coliforms showed a transient increase.
- A significant association was found between preoperative H. influenzae carriage and the development of chest infections (6 out of 8 bacterial causes).
- H. influenzae was more prevalent in cigarette smokers.
Conclusions:
- Preoperative oropharyngeal colonization by H. influenzae is a risk factor for postoperative chest infections.
- Cigarette smoking contributes to this risk, likely through increased H. influenzae colonization.
- Targeted interventions for H. influenzae carriers, especially smokers, may reduce postoperative respiratory complications.