Poor outcomes after hepatectomy in patients with ascites infected by methicillin-resistant staphylococci
Hidetoshi Nitta1, Toru Beppu, Akari Itoyama
1Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Background:
This study was designed to investigate the association between infectious ascites, clinical parameters and treatment outcomes after hepatectomy.
Methods:
Of 891 patients who underwent hepatectomy between 2006 and 2013, 74 who underwent paracentesis for bacterial cultivation of postoperative ascites after hepatectomy were analyzed.
Results:
Of the 74 patients, 42 had positive bacterial cultures (positive group) and 32 patients had negative cultures (negative group). Hospital mortality was significantly higher in the positive group than in the negative group [9/42 (21.4%) vs. 2/32 (6.3%); P = 0.035]. Hospital mortality associated with each bacterial strain was as follows: methicillin-resistant staphylococci (MRS) (5/13, 38.5%), staphylococci (2/11, 18.2%), enterococci (2/12, 16.7%), Enterobacter (0/3, 0%), Klebsiella (0/2, 0%), and others (0/1, 0%). Cox proportional multivariate analysis revealed that MRS infection in ascites was the only risk factor of hospital death (HR = 5.08, P = 0.041) and MRS wound infection was the only risk factor to predict MRS infection in ascites (HR = 5.67, P = 0.015).
Conclusion:
Postoperative MRS infection in postoperative ascites after hepatectomy is a potentially fatal complication; therefore, the prevention of MRS wound infection is critical to decrease postoperative hospital mortality.
Insights
Postoperative ascites infection after hepatectomy, especially methicillin-resistant staphylococci (MRS), significantly increases hospital mortality. Preventing MRS wound infections is crucial for reducing deaths following liver surgery.
Area of Science:
- Hepatobiliary Surgery
- Infectious Diseases
- Clinical Microbiology
Background:
- Postoperative ascites is a common complication after hepatectomy.
- The role of infectious ascites in clinical outcomes remains under investigation.
Purpose of the Study:
- To investigate the association between infectious ascites, clinical parameters, and treatment outcomes after hepatectomy.
- To identify risk factors for mortality in patients with postoperative ascites.
Main Methods:
- Retrospective analysis of 74 patients who underwent paracentesis for postoperative ascites after hepatectomy.
- Bacterial cultivation of ascites fluid to differentiate between positive and negative cultures.
- Cox proportional multivariate analysis to identify risk factors for hospital death and MRS infection.
Main Results:
- 42 patients had positive bacterial cultures, compared to 32 with negative cultures.
- Hospital mortality was significantly higher in the positive group (21.4%) versus the negative group (6.3%).
- Methicillin-resistant staphylococci (MRS) infection was the only identified risk factor for hospital death (HR=5.08, P=0.041), and MRS wound infection predicted ascites infection (HR=5.67, P=0.015).
Conclusions:
- Postoperative infectious ascites, particularly MRS, is a critical and potentially fatal complication after hepatectomy.
- Preventing methicillin-resistant staphylococci wound infections is essential for reducing postoperative mortality.
- Early identification and management of infectious ascites are vital for improving patient outcomes.
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