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Multi-Drug-Resistant Bacterial Infection after Pancreatoduodenectomy: Risk Factors and Clinical Impact
Junfeng Zhang1, Yang Fu2, Chaoyi Lin1
1Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Abstract:
Infection by multi-drug-resistant (MDR) bacteria is a high-risk factor for poor clinical results. Pancreatoduodenectomy (PD) has been associated with a high rate of complications, including intra-abdominal infections. However, there are few data available regarding MDR infection in patients undergoing PD. This study evaluated the present situation of risk factors for and clinical impact of MDR infection on patients who received PD. A total of 357 consecutive patients who underwent PD in our department from January 2016 to June 2018 were analyzed retrospectively. They were grouped into those with MDR infection (observation group) and those without MDR infection (control group). Univariable and multivariable analyses were used to identify risk factors for MDR infection in the two groups and the relations between MDR infection and clinical outcome. Infections by MDR bacteria occurred in 38 patients (10.6%), and a total of 49 MDR bacterial strains were detected. Carbapenem-resistant Acinetobacter baumannii and MDR Pseudomonas aeruginosa were the most common strains. Multivariable analysis suggested that pancreatic fistula (p = 0.001) and post-operative use of quinolones (p = 0.000) were risk factors for MDR infection. At the same time, MDR infection was an independent risk factor for an increase in the 30-day in-hospital mortality rate (p = 0.005). Intensive intra-operative management to reduce the incidence of pancreatic fistula as well as curtailing empirical use of antibiotics, especially quinolones, may help to reduce the incidence of MDR infection and thus in-hospital deaths.
Insights
Multi-drug-resistant (MDR) bacterial infections are a significant risk after pancreatoduodenectomy (PD). Pancreatic fistula and quinolone use increase MDR risk, which is linked to higher mortality rates.
Area of Science:
- Infectious Diseases
- Surgical Oncology
- Clinical Microbiology
Background:
- Multi-drug-resistant (MDR) bacterial infections pose a significant threat to patient outcomes, particularly in complex surgical procedures.
- Pancreatoduodenectomy (PD) is associated with a high incidence of complications, including intra-abdominal infections, yet data on MDR infections post-PD are limited.
Purpose of the Study:
- To investigate the prevalence, risk factors, and clinical impact of MDR infections in patients undergoing pancreatoduodenectomy (PD).
Main Methods:
- Retrospective analysis of 357 patients who underwent PD between January 2016 and June 2018.
- Patients were categorized into MDR infection (observation) and no MDR infection (control) groups.
- Univariable and multivariable analyses were employed to identify risk factors and clinical outcomes.
Main Results:
- MDR infections occurred in 10.6% of patients, with carbapenem-resistant *Acinetobacter baumannii* and MDR *Pseudomonas aeruginosa* being the most common pathogens.
- Pancreatic fistula and post-operative quinolone use were identified as independent risk factors for MDR infection.
- MDR infection was independently associated with an increased 30-day in-hospital mortality rate.
Conclusions:
- Reducing pancreatic fistula incidence through intensive intra-operative management is crucial.
- Curtailing empirical antibiotic use, especially quinolones, may decrease MDR infections and associated in-hospital deaths following PD.
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