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

Video：

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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

1.	孙备, 陈华. 胰腺癌外科治疗的现状与展望[J]. 中国普外基础与临床杂志, 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.	刘战培, 蒲青凡, 周勇. 233例胰十二指肠切除术后并发症及死亡危险因素多因素分析[J]. 中国普外基础与临床杂志, 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.	易建华, 曾令兰, 姜伟超, 等. 158例腹腔感染患者致病菌谱及耐药性分析[J]. 中华医院感染学杂志, 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.	吴安华, 任南, 文细毛, 等. 我国178所医院住院患者横断面抗菌药物使用率调查[J]. 中华医院感染学杂志, 2002, 12(12):881-884.
15.	李玉, 李艳. 产β-内酰胺酶肠杆菌科细菌对氟喹喏酮类抗生素体外抗菌活性研究[J]. 中华医院感染学杂志, 2002, 12(12):935-936.
16.	杨国山, 杜斌, 吴增安, 等. 外科危重病患者的抗生素使用[J]. 中华医院感染学杂志, 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.	杨峰, 傅德良, 金忱, 等. 胰十二指肠切除术后腹腔感染细菌学和耐药性及其危险因素分析[J]. 中华普通外科杂志, 2007, 22(2):99-103.
19.	张波, 曾庆东, 李胜, 等. 胰十二指肠切除术后腹腔感染发生的影响因素[J]. 中国普通外科杂志, 2004, 13(2):127-129.
20.	向颖, 徐明清, 严律南, 等. 胰十二指肠切除术中胰肠吻合方式与术后胰漏及吻合口出血的相关性研究[J]. 中国普外基础与临床杂志, 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.	吕飞飞, 赵海平, 胡文秀, 等. 胰十二指肠切除术围手术期并发症临床分析[J]. 中国普外基础与临床杂志, 2013, 20(7):728-731.
24.	牛宪忠, 唐凌, 杨俊杰. 纤维支气管镜对COPD患者下呼吸道病原菌的诊断价值[J]. 中国内镜杂志, 1999, 5(2):21.
25.	蒋秀芳. 支气管肺泡灌洗术的安全性[M]. 国外医学内科学分册, 1996, 23(12):522-524.

1. 孙备, 陈华. 胰腺癌外科治疗的现状与展望[J]. 中国普外基础与临床杂志, 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. 刘战培, 蒲青凡, 周勇. 233例胰十二指肠切除术后并发症及死亡危险因素多因素分析[J]. 中国普外基础与临床杂志, 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. 易建华, 曾令兰, 姜伟超, 等. 158例腹腔感染患者致病菌谱及耐药性分析[J]. 中华医院感染学杂志, 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. 吴安华, 任南, 文细毛, 等. 我国178所医院住院患者横断面抗菌药物使用率调查[J]. 中华医院感染学杂志, 2002, 12(12):881-884.
15. 李玉, 李艳. 产β-内酰胺酶肠杆菌科细菌对氟喹喏酮类抗生素体外抗菌活性研究[J]. 中华医院感染学杂志, 2002, 12(12):935-936.
16. 杨国山, 杜斌, 吴增安, 等. 外科危重病患者的抗生素使用[J]. 中华医院感染学杂志, 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. 杨峰, 傅德良, 金忱, 等. 胰十二指肠切除术后腹腔感染细菌学和耐药性及其危险因素分析[J]. 中华普通外科杂志, 2007, 22(2):99-103.
19. 张波, 曾庆东, 李胜, 等. 胰十二指肠切除术后腹腔感染发生的影响因素[J]. 中国普通外科杂志, 2004, 13(2):127-129.
20. 向颖, 徐明清, 严律南, 等. 胰十二指肠切除术中胰肠吻合方式与术后胰漏及吻合口出血的相关性研究[J]. 中国普外基础与临床杂志, 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. 吕飞飞, 赵海平, 胡文秀, 等. 胰十二指肠切除术围手术期并发症临床分析[J]. 中国普外基础与临床杂志, 2013, 20(7):728-731.
24. 牛宪忠, 唐凌, 杨俊杰. 纤维支气管镜对COPD患者下呼吸道病原菌的诊断价值[J]. 中国内镜杂志, 1999, 5(2):21.
25. 蒋秀芳. 支气管肺泡灌洗术的安全性[M]. 国外医学内科学分册, 1996, 23(12):522-524.

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Clinical Research on The Intra-Abdominal Infection after Pancreaticoduodenectomy

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