Causative bacteria associated with a clinically relevant postoperative pancreatic fistula infection after distal
Hiroaki Osakabe1, Yuichi Nagakawa2, Shingo Kozono1
1Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Purpose:
Clinically relevant postoperative pancreatic fistulas (CR-POPF) occurring after distal pancreatectomy often cause intra-abdominal infections. We monitored the presence of bacterial contamination in the ascitic fluid after distal pancreatectomy to clarify the bacterial origin of intra-abdominal infections associated with CR-POPF.
Methods:
In 176 patients who underwent distal pancreatectomy, ascitic fluid bacterial cultures were performed on postoperative days (POD) 1-4 and when the drainage fluid became turbid. The association between postoperative ascitic bacterial contamination and CR-POPF incidence was investigated.
Results:
CR-POPF occurred in 18 cases (10.2%). Among the patients with CR-POPF, bacterial contamination was detected in 0% on POD 1, in 38.9% on POD 4, and in 72.2% on the day (median, day 9.5) when the drainage fluid became turbid. A univariate analysis revealed a significant difference in ascitic bacterial contamination on POD 4 (p < 0.001) and amylase level on POD 3-4 (p < 0.001). A multivariate analysis revealed the amylase level and ascitic bacterial contamination on POD 4 to be independent risk factors.
Conclusions:
In the CR-POPF group, ascitic bacterial contamination was not observed in the early postoperative stage, but the bacterial contamination rate increased after pancreatic juice leakage occurred. Therefore, CR-POPF-related infections in distal pancreatectomy may be caused by a retrograde infection of pancreatic juice.
Insights
Clinically relevant postoperative pancreatic fistulas (CR-POPF) after distal pancreatectomy are linked to intra-abdominal infections. Bacterial contamination of ascitic fluid increases after pancreatic juice leakage, suggesting a retrograde infection pathway.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Infections
- Pancreatic Surgery
Background:
- Clinically relevant postoperative pancreatic fistulas (CR-POPF) are a significant complication following distal pancreatectomy.
- These fistulas often lead to intra-abdominal infections, posing a risk to patient recovery.
- Understanding the origin of these infections is crucial for effective management.
Purpose of the Study:
- To investigate the presence and timing of bacterial contamination in ascitic fluid after distal pancreatectomy.
- To clarify the bacterial origin of intra-abdominal infections associated with CR-POPF.
- To identify risk factors for CR-POPF-related infections.
Main Methods:
- A cohort of 176 patients undergoing distal pancreatectomy was studied.
- Ascitic fluid bacterial cultures were performed on postoperative days 1-4 and when drainage fluid became turbid.
- Statistical analyses, including univariate and multivariate analyses, were used to assess the association between bacterial contamination and CR-POPF.
Main Results:
- CR-POPF occurred in 10.2% of patients.
- Bacterial contamination in the CR-POPF group was 0% on postoperative day 1, increasing to 38.9% on day 4 and 72.2% when drainage fluid became turbid (median day 9.5).
- Ascitic bacterial contamination on postoperative day 4 and elevated amylase levels on postoperative days 3-4 were identified as independent risk factors for CR-POPF.
Conclusions:
- Bacterial contamination of ascitic fluid in CR-POPF patients is not present in the early postoperative period.
- The rate of bacterial contamination increases significantly after pancreatic juice leakage occurs.
- These findings suggest that CR-POPF-related infections may result from a retrograde infection of pancreatic juice.
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