Postoperative infections in immunocompromised patients after oncological surgery

Abstract

Immunodeficiency secondary to cancer chemotherapy (chemotherapy for less than 3 months, or intensive chemotherapy with bone marrow transplant) may be responsible for postoperative infections. To estimate the value of this hypothesis, a prospective study was done over a period of 18 months in patients who had undergone pulmonary surgery. Antibiotic prophylaxis was by pefloxacin, one tablet (400 mg) 1 h before surgery then 11 h after. Clinical examination, a chest X-ray and blood cell count were carried out every day for 10 days and on the 15th day. All the drain-tips were cultured. In a case of infection, samples were obtained and cultured. One group comprised 22 immunodeficient patients (group A), and 33 patients (group B) had received no prior chemotherapy (bone-marrow transplantation = 36.7%). There were differences between the two groups in age (A:33.5 +/- 12.3 years; B:50.8 +/- 18.4 years), and type of tumour (A: metastasis = 95.5%; B: lung cancer = 51.5%). Surgical operation was bilateral for 36.4% of the patients in group A. There was more anatomical resection (pneumonectomy and lobectomy) in group B. Lung function did not differ between the two groups (abnormalities: A = 54.6%; B = 63.6%). In group A, there were 3 pulmonary infections (13.7%), but in group B 10 infections (30.3%) with 9 pulmonary infections (4 with bacteraemia) and 1 wound infection. The bacteriological finding showed two pathogens in 7 cases and no bacteriological isolates in 2 cases. With broad-spectrum antibiotherapy all the patients were cured except 1. There was one postoperative death in group B. This patient died of respiratory distress after pneumonectomy complicated by pneumonia and septicaemia (Streptococcus pneumoniae) in the remaining lung. Surgical procedures are performed with increasing frequency on patients with immunocompromised status. Classically the risk of infection is more important for these patients. In this study prior cancer chemotherapy or bone marrow transplantation did not seem to be an aggravating factor of the risk of infection. But further methodological analysis would not allow us to distinguish between a real impact of chemotherapy and the influence of group heterogeneity.