Clinical Research on The Intra-Abdominal Infection after Pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LILiu-cheng , HANWei , LINHai , HETie-ying ,  CHENQi-long

Department of Pancreatic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uyghur Autonomous Region, China;

Corresponding?author：

CHENQi-long, Email: chenqilong651003@sohu.com

Keywords：

Intra-abdominal infection; Pancreaticoduodenectomy; Microbial infection; Influencing factor

DOI：

10.7507/1007-9424.20140273

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Objective To investigate the main characteristics of intro-abdominal microbial infection and the risk factors for it after pancreaticoduodenectomy. Methods Clinical data of 200 patients underwent pancreaticoduodenectomy at the First Affiliated Hospital of Xinjiang Medical University from Sep. 2008 to Sep. 2013 were reviewed retrospectively to investigate the main characteristics of abdominal microbial infection after pancreaticoduodenectomy and risk factors for it. Results Of the 200 patients, cultures of drainage fluids were positive in 78 patients, and 42 of them(21.0%) met the diagnosis of intra-abdominal infection criterion. One hundred and eighty-five pathogenic strains were isolated totally, 64 strains of them(34.6%) were Gram positive cocci, 103 strains(55.7%) were Gram negative bacilli, and 18 strains (9.7%) were fungus. The top 5 kinds of bacteria in order were Staphylococcus aureus(31 strains), Pseudomonas aemginosa(28 strains), Escherichia co1i(22 strains), Klebsiella pneumoniae(18 strains), and Enterococcus faecium (14 strains). Most of the pathogens were resistant to broad-spectrum antibiotics. The resistance rate of Pseudomonas aeruginosa was 60.7%(17/28) to imipenem. Extended spectrum beta lactamases(ESBLs)-producing strains accounted for 22.7%(5/22) and 33.3%(6/18) in Escherichia coli and Klebsiella pneumoniae respectively. The detection rate of methicillin resistant staphylococcus aureus(MRSA) was 45.2%(14/31) in Staphylococcus aureus. Multivariate logistic regression analysis results showed that status of pancreatic fistula and pulmonary infection were the risk factors for intraabdominal infection, patients with high grade of pancreatic fistula(OR=16.252, P=0.003) and with pulmonary infection (OR=2.855, P=0.017) had higher incidence of intra-abdominal infection. Conclusion Gram negative bacilli is the main pathogenic bacteria of abdominal drainage fluids cultivation of microbiology after pancreaticoduodenectomy. Most of them have multi-drug resistance characteristic. Positive prevention and treatment of pancreatic fistula and pulmonary infection can reduce the incidence of intra-abdominal infection.

Citation： LILiu-cheng, HANWei, LINHai, HETie-ying, CHENQi-long. Clinical Research on The Intra-Abdominal Infection after Pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(9): 1138-1144. doi: 10.7507/1007-9424.20140273 Copy

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2.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition[J]. Surgery, 2005, 138(1):8-13.
3.	Bassi C, Butturini G, Molinari E, et al. Pancreatic fistula rate after pancreatic resection. The importance of definitions[J]. Dig Surg, 2004, 21(1):54-59.
4.	Shrikhande SV, Qureshi SS, Rajneesh N, et al. Pancreatic anastomoses after pancreaticoduodenectomy:do we need further studies?[J]. World J Surg, 2005, 29(12):1642-1649.
5.	劉戰培, 蒲青凡, 周勇. 233例胰十二指腸切除術后并發癥及死亡危險因素多因素分析[J]. 中國普外基礎與臨床雜志, 2008,15(3):195-200.
6.	Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s:pathology, complications, and outcomes[J]. Ann Surg, 1997, 226(3):248-260.
7.	Klyachkin ML, Dhillon JS, Kaveh SJ, et al. Current management of severe intraabdominal infection[J]. Curr Surg, 1998, 55:39-45.
8.	Dilworth JP, White RJ. Postopertive chest infection after upper abdominal surgery:an important problem for smokers[J]. Respire Med, 1992, 86(3):205-210.
9.	Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery:a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)[J]. Surgery, 2007, 142(5):761-768.
10.	National Committee of Clinical Laboratory Stands. Performance standards for antimicrobial susceptibility testing;fourteenth informational supplement[M]. Wayne Pennsylvania:NCCLS, 2004:1-159.
11.	Hau T. Bacteria, toxins, and the peritoneum[J]. World J Surg, 1990, 14(2):167-175.
12.	易建華, 曾令蘭, 姜偉超, 等. 158例腹腔感染患者致病菌譜及耐藥性分析[J]. 中華醫院感染學雜志, 2001, 11(3):163-165.
13.	Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee[J]. JAMA, 1995, 274(8):639-644.
14.	吳安華, 任南, 文細毛, 等. 我國178所醫院住院患者橫斷面抗菌藥物使用率調查[J]. 中華醫院感染學雜志, 2002, 12(12):881-884.
15.	李玉, 李艷. 產β-內酰胺酶腸桿菌科細菌對氟喹喏酮類抗生素體外抗菌活性研究[J]. 中華醫院感染學雜志, 2002, 12(12):935-936.
16.	楊國山, 杜斌, 吳增安, 等. 外科危重病患者的抗生素使用[J]. 中華醫院感染學雜志, 2005, 15(5):565-567.
17.	Lygidakis NJ, Jain S, Sacchi M, et al. Reappraisal of a method of reconstruction after pancreatoduodenectomy[J]. Hepatogatroenterology, 2005, 52(64):1077-1082.
18.	楊峰, 傅德良, 金忱, 等. 胰十二指腸切除術后腹腔感染細菌學和耐藥性及其危險因素分析[J]. 中華普通外科雜志, 2007, 22(2):99-103.
19.	張波, 曾慶東, 李勝, 等. 胰十二指腸切除術后腹腔感染發生的影響因素[J]. 中國普通外科雜志, 2004, 13(2):127-129.
20.	向穎, 徐明清, 嚴律南, 等. 胰十二指腸切除術中胰腸吻合方式與術后胰漏及吻合口出血的相關性研究[J]. 中國普外基礎與臨床雜志, 2013, 20(5):503-507.
21.	Reid-Lombardo KM, Famell MB, Crippa S, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1507 patients:a report from the Pancreatic Anastomotic Leak Study Group[J]. J Gastrointest Surg, 2007, 11(11):1451-1459.
22.	Berger AC, Howard TJ, Kennedy EP, et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial[J]. J Am Coll Surg, 2009, 208(5):738-749.
23.	呂飛飛, 趙海平, 胡文秀, 等. 胰十二指腸切除術圍手術期并發癥臨床分析[J]. 中國普外基礎與臨床雜志, 2013, 20(7):728-731.
24.	牛憲忠, 唐凌, 楊俊杰. 纖維支氣管鏡對COPD患者下呼吸道病原菌的診斷價值[J]. 中國內鏡雜志, 1999, 5(2):21.
25.	蔣秀芳. 支氣管肺泡灌洗術的安全性[M]. 國外醫學內科學分冊, 1996, 23(12):522-524.

1. 孫備, 陳華. 胰腺癌外科治療的現狀與展望[J]. 中國普外基礎與臨床雜志, 2008, 15(8):547-549.
2. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition[J]. Surgery, 2005, 138(1):8-13.
3. Bassi C, Butturini G, Molinari E, et al. Pancreatic fistula rate after pancreatic resection. The importance of definitions[J]. Dig Surg, 2004, 21(1):54-59.
4. Shrikhande SV, Qureshi SS, Rajneesh N, et al. Pancreatic anastomoses after pancreaticoduodenectomy:do we need further studies?[J]. World J Surg, 2005, 29(12):1642-1649.
5. 劉戰培, 蒲青凡, 周勇. 233例胰十二指腸切除術后并發癥及死亡危險因素多因素分析[J]. 中國普外基礎與臨床雜志, 2008,15(3):195-200.
6. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s:pathology, complications, and outcomes[J]. Ann Surg, 1997, 226(3):248-260.
7. Klyachkin ML, Dhillon JS, Kaveh SJ, et al. Current management of severe intraabdominal infection[J]. Curr Surg, 1998, 55:39-45.
8. Dilworth JP, White RJ. Postopertive chest infection after upper abdominal surgery:an important problem for smokers[J]. Respire Med, 1992, 86(3):205-210.
9. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery:a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)[J]. Surgery, 2007, 142(5):761-768.
10. National Committee of Clinical Laboratory Stands. Performance standards for antimicrobial susceptibility testing;fourteenth informational supplement[M]. Wayne Pennsylvania:NCCLS, 2004:1-159.
11. Hau T. Bacteria, toxins, and the peritoneum[J]. World J Surg, 1990, 14(2):167-175.
12. 易建華, 曾令蘭, 姜偉超, 等. 158例腹腔感染患者致病菌譜及耐藥性分析[J]. 中華醫院感染學雜志, 2001, 11(3):163-165.
13. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee[J]. JAMA, 1995, 274(8):639-644.
14. 吳安華, 任南, 文細毛, 等. 我國178所醫院住院患者橫斷面抗菌藥物使用率調查[J]. 中華醫院感染學雜志, 2002, 12(12):881-884.
15. 李玉, 李艷. 產β-內酰胺酶腸桿菌科細菌對氟喹喏酮類抗生素體外抗菌活性研究[J]. 中華醫院感染學雜志, 2002, 12(12):935-936.
16. 楊國山, 杜斌, 吳增安, 等. 外科危重病患者的抗生素使用[J]. 中華醫院感染學雜志, 2005, 15(5):565-567.
17. Lygidakis NJ, Jain S, Sacchi M, et al. Reappraisal of a method of reconstruction after pancreatoduodenectomy[J]. Hepatogatroenterology, 2005, 52(64):1077-1082.
18. 楊峰, 傅德良, 金忱, 等. 胰十二指腸切除術后腹腔感染細菌學和耐藥性及其危險因素分析[J]. 中華普通外科雜志, 2007, 22(2):99-103.
19. 張波, 曾慶東, 李勝, 等. 胰十二指腸切除術后腹腔感染發生的影響因素[J]. 中國普通外科雜志, 2004, 13(2):127-129.
20. 向穎, 徐明清, 嚴律南, 等. 胰十二指腸切除術中胰腸吻合方式與術后胰漏及吻合口出血的相關性研究[J]. 中國普外基礎與臨床雜志, 2013, 20(5):503-507.
21. Reid-Lombardo KM, Famell MB, Crippa S, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1507 patients:a report from the Pancreatic Anastomotic Leak Study Group[J]. J Gastrointest Surg, 2007, 11(11):1451-1459.
22. Berger AC, Howard TJ, Kennedy EP, et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial[J]. J Am Coll Surg, 2009, 208(5):738-749.
23. 呂飛飛, 趙海平, 胡文秀, 等. 胰十二指腸切除術圍手術期并發癥臨床分析[J]. 中國普外基礎與臨床雜志, 2013, 20(7):728-731.
24. 牛憲忠, 唐凌, 楊俊杰. 纖維支氣管鏡對COPD患者下呼吸道病原菌的診斷價值[J]. 中國內鏡雜志, 1999, 5(2):21.
25. 蔣秀芳. 支氣管肺泡灌洗術的安全性[M]. 國外醫學內科學分冊, 1996, 23(12):522-524.

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Clinical Research on The Intra-Abdominal Infection after Pancreaticoduodenectomy

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