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Published on: November 14, 2020
Identification of Bacterial and Fungal Pathogens in Patients with Post-Laparoscopic Sleeve Gastrectomy Leakage
Saad Althuwaini1, Fahad Bamehriz2, Omar Alobaid2
1Surgery Department, Upper GI Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. althuwaini83@gmail.com.
Background:
Post-laparoscopic sleeve gastrectomy (LSG) leak leads to serious complications, and death may occur. The microbial pattern should be established in order to plan empirical antimicrobial therapy. The intra-abdominal leaks post-LSG were cultured and reviewed.
Methods:
Microbial cultures collected from all post-sleeve leakage cases managed at the King Khalid University Hospital (KKUH) from May 2011 until April 2016 were reviewed.
Results:
A total of 31 patients with positive leak post-LSG were included. The mean presentation time was postoperative day 12. Computed tomography (CT) was done for all patients on presentation with CT-guided aspiration and drainage next day. Samples from the collection were aspirated first for culture then a pigtail drain was kept in place. The average time of drain removal was on the 75th postoperative day. A total of 28 patients (90.3%) had positive culture results. Candida species were the most common organism isolated from 19 patients (61.2%), among them, 10 (32.2%) were positive for Candida species only. Positive bacterial cultures were found in 18 patients (58%). Majority of which single bacterial pathogen isolate, only seven patients had two organisms, and four patients had three organisms. Klebsiella pneumoniae was the most frequent isolated bacteria [8 patients (44.4%)] followed by Streptococcus and Pseudomonas species. Candida albicans was the most common Candida species isolated, 13 patients (68.4%).
Conclusion:
Fungal microbes isolated from post-LSG leak collection are common and could be considered in the primary empirical therapy. The antibiotic choice for the leak should cover Klebsiella, Streptococcus, and Pseudomonas until definitive culture results are obtained.
Insights
Fungal microbes, particularly Candida species, are common in post-laparoscopic sleeve gastrectomy leaks. Empirical antimicrobial therapy for these leaks should also target common bacteria like Klebsiella, Streptococcus, and Pseudomonas.
Area of Science:
- Gastroenterology
- Surgical Infections
- Microbiology
Background:
- Post-laparoscopic sleeve gastrectomy (LSG) leaks can cause severe complications and mortality.
- Understanding the microbial patterns in these leaks is crucial for effective empirical antimicrobial therapy.
Purpose of the Study:
- To establish the microbial pattern of intra-abdominal leaks following LSG.
- To inform empirical antimicrobial treatment strategies for post-LSG leaks.
Main Methods:
- Review of microbial cultures from 31 patients with post-LSG leaks managed at King Khalid University Hospital (May 2011-April 2016).
- Computed tomography (CT)-guided aspiration and drainage for leak collection.
- Analysis of culture results for fungal and bacterial organisms.
Main Results:
- 90.3% of patients had positive culture results.
- Candida species were the most common isolates (61.2%), with Candida albicans being the most frequent (68.4% of Candida).
- Bacterial cultures were positive in 58% of patients, with Klebsiella pneumoniae (44.4%), Streptococcus, and Pseudomonas species being the most frequent.
Conclusions:
- Fungal microbes are prevalent in post-LSG leak collections and should be considered in initial empirical therapy.
- Empirical antibiotic selection for post-LSG leaks should include coverage for Klebsiella, Streptococcus, and Pseudomonas pending definitive culture results.
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