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Abstract
Introduction Post-operative respiratory infection is a significant complication of thoracic surgery, associated with significant morbidity and high mortality. Patients undergoing thoracic surgical intervention with underlying lung disease, including COPD, often have chronic infection or colonisation. Peri-procedural microbiological airway sampling can potentially warn of pathogenic infection early in the clinical course, and guide treatment. We studied clinical characteristics and microbiological samples in patients undergoing thoracic intervention at a tertiary teaching hospital between 2012–2019.
Methods A retrospective case-note review of 224 patients undergoing either lung resection for presumed lung cancer or insertion of endobronchial valves (EBV) was carried out. Data collection included demographics, lung function and microbiology from bronchoscopy at the time of intervention. Agreement between a respiratory physician and thoracic surgeon regarding antibiotic prescribing based on microbiology result was also investigated.
Results Four patient groups were categorised. EBV (n=56), COPD lung resection (n=51), Ex-smokers non-COPD lung resection (n=64) and Never-smokers non-COPD lung resection (n=51). The mean age was 67.3 (SD 10.1). Patients with COPD undergoing EBV insertion had the lowest FEV% predicted (mean 34.9%, SD 13.7) compared to ex-smokers without COPD (mean 93.4%, SD 23.9) and never-smokers without COPD (mean 106.3%, SD 22.5).
Normal respiratory flora made up 73% of the EBV, 79% of the COPD lung resection, 91% of the Ex-smokers lung resection and 84% of the Never smoker groups’ positive cultures. Haemophilus influenzae was the commonest pathogen found (29% of pathogenic cultures in the EBV group, compared to 20%, 10% and 15% in the ex-smokers with COPD, ex-smokers without COPD, and never-smoker groups respectively).
When responses from a thoracic surgeon and a respiratory physician regarding treatment decisions based on pathogen identified were considered, the agreement rate varied between 33% and 69%, depending on the patient group (Kappa range from 0 to 0.44).
Conclusion There are differences between the characteristics of microbiological cultures from patients undergoing thoracic surgery, depending on their smoking status, COPD diagnosis and COPD severity. Airway sampling may aid antibiotic decision-making in patients undergoing thoracic surgery however, differences in antibiotic prescribing between clinicians highlights the need for more research into this area and consensus on treatment decisions.
Clinician agreement on pathogen treatment decisions