Chest tube tip culture as a predictor of postoperative infection in lung cancer operations.

BACKGROUND: Postoperative infection is one of the most frequently observed complications after lung resection and should be addressed in perioperative management. This study evaluated the clinical significance of chest tube tip culture relevant to postoperative infection. METHODS: From September 2002 to December 2011, 1,438 patients who underwent lung cancer operations in Shizuoka Cancer Center Hospital were evaluated. Postoperative infections, including surgical site infection, postoperative pneumonia, and postoperative empyema without fistula, were defined as those occurring within 30 days of thoracotomy. RESULTS: Postoperative infections developed in 84 of the 1,438 patients (5.8%), including 42 (2.9%) with surgical site infection, 36 (2.5%) with pneumonia, and 13 (0.9%) with empyema. The sensitivity, specificity, and positive predictive value of chest tube tip culture were 23%, 98%, and 41.3%, respectively. Multivariate analysis demonstrated that the independent risk factors associated with the development of postoperative infections were coexisting diabetes mellitus and positive chest tube tip culture. Positive chest tube tip culture was the only independent risk factor associated with surgical site infection. The independent risk factors associated with postoperative pneumonia were age 70 years or older, coexisting diabetes mellitus, and positive chest tube tip culture. Finally, positive chest tube tip culture was the only independent risk factor associated with postoperative empyema. CONCLUSIONS: Positive chest tube tip culture strongly predicts postoperative infections in lung cancer surgery and necessitates careful observation in the perioperative period.

Nanotechnology: pediatric applications.

Ventilator-associated pneumonia (VAP) is a serious and costly clinical problem affecting pediatrics today. This device-related infection is thought to be directly linked to the colonization of the endotracheal tube (ETT) during long-term mechanical ventilation. Because of unspecific radiographic and clinical signs, VAP is especially difficult to diagnose in the pediatric population. Treatment with antibiotics is often ineffective, and VAP is associated with high morbidity, mortality, and medical costs. The use of nanomodified coatings on ETT may provide an effective strategy to prevent biofilm formation and ETT colonization. Nanoparticles such as selenium and iron oxide have been shown to penetrate into the biofilm reaching the protected cells antibiotics often miss. Moreover, nanoetching techniques can modify the topography of the ETT surface interfering with bacterial adhesion. This review seeks to examine the antimicrobial properties of both nanoparticles and nanomodified surfaces and to characterize their effectiveness at reducing bacterial colonization on ETT.

Chest tube-related empyema due to methicillin-resistant Staphylococcus aureus: could the chest tube be coated with antiseptics?

We reviewed the epidemiology, clinical manifestations, and outcomes of 3 cases of chest tube-related empyema due to methicillin-resistant Staphylococcus aureus (MRSA). Antiseptic-impregnated chest tubes were inserted in cultures containing MRSA isolates from these 3 patients, and zone of inhibition were measured. Chest tube-related MRSA empyema might complicate tube thoracostomy, and coating the chest tube with antiseptic agents could prevent this complication.

[Microflora colonizing pleural drains after thoracic surgery]. / Mikroflora kolonizujaca dreny po zabiegach torakochirurgicznych.

The aim of this paper was to analyse aerobic and anaerobic bacterial flora colonizing pleural drains in 32 patients with lung tumor undergoing pulmonary resection and receiving antimicrobial prophylaxis. Fluid from pleural drains was taken up on the day of operation and on the 3-rd or 4-th day after the operation. Significant number of aerobic bacteria, mainly methicillin-resistant coagulase-negative staphylococci and multidrug resistant Gram-negative rods, were isolated from 30 (46.9%) specimens. Lower number of anaerobic bacteria were found in 24 (37.5%) specimens. Colonization of the pleural drains does not mean infection, (in only one patient isolated Pseudomonas aeruginosa could be the etiologic agent of infection) however knowledge about bacterial species found in drain fluid in a local population and drug susceptibility of isolated strains allows to propose effective antimicrobial prophylaxis.