Abstract
BackgroundPost-operative pulmonary infection often appears to result from aspiration of pathogens colonizing the oral cavity. It was hypothesized that impaired periodontal status and pathogenic oral bacteria significantly contribute to development of aspiration pneumonia following neurosurgical operations. Further, the prophylactic effects of a single dose preoperative cefazolin on the oral bacteria were investigated.MethodsA matched cohort of 18 patients without postoperative lung complications was compared to 5 patients who developed pneumonia within 48 hours after brain surgery. Patients waiting for elective operation of a single brain tumor underwent dental examination and saliva collection before surgery. Bacteria from saliva cultures were isolated and periodontal disease was scored according to type and severity. Patients received 15 mg/kg cefazolin intravenously at the beginning of surgery. Serum, saliva and bronchial secretion were collected promptly after the operation. The minimal inhibitory concentrations of cefazolin regarding the isolated bacteria were determined. The actual antibiotic concentrations in serum, saliva and bronchial secretion were measured by capillary electrophoresis upon completion of surgery. Bacteria were isolated again from the sputum of postoperative pneumonia patients.ResultsThe number and severity of coexisting periodontal diseases were significantly greater in patients with postoperative pneumonia in comparison to the control group (p = 0.031 and p = 0.002, respectively). The relative risk of developing postoperative pneumonia in high periodontal score patients was 3.5 greater than in patients who had low periodontal score (p < 0.0001). Cefazolin concentration in saliva and bronchial secretion remained below detectable levels in every patient.ConclusionPresence of multiple periodontal diseases and pathogenic bacteria in the saliva are important predisposing factors of postoperative aspiration pneumonia in patients after brain surgery. The low penetration rate of cefazolin into the saliva indicates that its prophylactic administration may not be sufficient to prevent postoperative aspiration pneumonia. Our study suggests that dental examination may be warranted in order to identify patients at high risk of developing postoperative respiratory infections.
Highlights
Post-operative pulmonary infection often appears to result from aspiration of pathogens colonizing the oral cavity
When serum cefazolin concentrations were compared between control and pneumonia patients (Figure 3C) we found no significant difference suggesting that there was no relationship between circulating cefazolin levels and presence of pneumonia after brain surgery
In this study we investigated the significance of periodontal diseases in postoperative pneumonia and the effects of preoperative cefazolin prophylaxis on the oral pathogen flora in older patients after neurosurgical operation
Summary
Post-operative pulmonary infection often appears to result from aspiration of pathogens colonizing the oral cavity. It was hypothesized that impaired periodontal status and pathogenic oral bacteria significantly contribute to development of aspiration pneumonia following neurosurgical operations. Patients requiring a prolonged surgical procedure with mechanical respiratory support frequently develop post operative or ventilator-associated pneumonia that increases morbidity, mortality and length of recovery [16]. While several different routes have been suggested, in most cases the pulmonary infection appears to result from aspiration of pathogens colonizing the oral cavity. Aspiration of oropharyngeal secretions can be facilitated by leakage around the endotracheal tube cuff, weakness of pharyngeal and coughing reflexes, impaired level of consciousness, and postoperative immobilization [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
