Clinical usefulness of a perioperative bacteriological culture to treat patients with postoperative pneumonia after esophagectomy

Abstract

Aim: The aim of the present study was to examine the usefulness of a perioperative bacteriological culture in predicting the pathogenic bacteria responsible for postoperative pneumonia after esophagectomy. Methods: This study included 293 consecutive esophageal cancer patients who underwent esophagectomy with gastric conduit reconstruction. We compared the pathological bacteria that were detected in bacteriological cultures of sputum, mouthwash and gastric fluid on the second postoperative day with the pathogenic bacteria responsible for postoperative pneumonia. Results: Postoperative pneumonia occurred in 26 (8.8%) of the 293 patients. Enterobacter cloacae was detected most frequently in the perioperative bacteriological culture, followed by Enterococcus faecalis and Pseudomonas aeruginosa. Detection of each pathogenic bacterium in the perioperative bacteriological culture was not associated with the occurrence of pneumonia, excluding Pseudomonas aeruginosa. As the pathogens responsible for postoperative pneumonia, 32 bacteria were detected in 26 patients with postoperative pneumonia. Detection rate of the pathogenic bacteria responsible for postoperative pneumonia in a perioperative bacteriological culture was 43.8% in a sputum culture, 40.6% in a mouthwash culture and 65.6% in a gastric fluid culture. The detection rate of the pathogenic bacteria responsible for pneumonia was up to 78.1% in the combination of sputum and gastric fluid culture. Conclusions: Although the perioperative bacteriological culture does not seem to be useful for predicting the occurrence of postoperative pneumonia, it is useful for predicting the pathogenic bacteria responsible for pneumonia in cases of postoperative pneumonia. The perioperative bacteriological culture helps us to select appropriate antibiotics to treat pneumonia after esophagectomy.