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Risk factors and microbial spectrum for infectious complications after pancreaticoduodenectomy
Xu Fu1,2, Yifei Yang2, Liang Mao2
1Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Background:
Although the mortality of pancreaticoduodenectomy (PD) has decreased, the morbidity especially infections is still a severe challenge. This study aimed to identify the risk factors and microbial spectrum for infectious complications after PD.
Methods:
This retrospective study of 291 consecutive patients who underwent PD between February 2018 and March 2021 was conducted. The clinical data was reviewed and risk factors associated with infectious complications were analyzed. To investigate the microbial spectrum, microorganisms isolated from preoperative bile, drainage fluid and blood were counted.
Results:
A total of 110 patients (37.8%) developed postoperative infections. The patients who suffered infections had higher severe complications, prolonged hospitalization and increased expenditures. Three independent risk factors were identified: preoperative biliary drainage (PBD) [odds ratio (OR) 2.082; 95% confidence interval (CI): 1.059-4.091; P=0.033], clinically relevant postoperative pancreatic fistula (CR-POPF) (OR 11.984; 95% CI: 6.556-21.471; P=0.000) and biliary fistula (BF) (OR 3.674; 95% CI: 1.218-11.084; P=0.021). K. pneumoniae and E. faecalis were the most frequently isolated bacteria in preoperative bile and drainage fluid after PD. K. pneumoniae and S. haemolyticus were the most common bacteria in bacteremia patients.
Conclusions:
PBD, POPF and BF are independent risk factors for infectious complications after PD. To lower the incidence of infection, PBD should be performed only in select cases and efforts should be taken to reduce the POPF and BF. The pathogens of bile and drainage fluid should be monitored throughout the hospital stay.
Insights
Infectious complications after pancreaticoduodenectomy (PD) are linked to preoperative biliary drainage, pancreatic fistula, and biliary fistula. Reducing these factors and monitoring pathogens can lower infection rates in PD patients.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Infectious Diseases
Background:
- Pancreaticoduodenectomy (PD) remains a challenging procedure with significant infectious morbidity despite decreased mortality.
- Identifying risk factors and understanding the microbial spectrum are crucial for managing postoperative infections after PD.
Purpose of the Study:
- To identify independent risk factors for infectious complications following pancreaticoduodenectomy (PD).
- To determine the microbial spectrum associated with infectious complications in PD patients.
Main Methods:
- Retrospective analysis of 291 patients undergoing PD between February 2018 and March 2021.
- Review of clinical data to identify risk factors for infectious complications.
- Microbial analysis of preoperative bile, drainage fluid, and blood samples.
Main Results:
- Postoperative infections occurred in 37.8% of patients, associated with severe complications, prolonged hospitalization, and increased costs.
- Independent risk factors for infection included preoperative biliary drainage (PBD), clinically relevant postoperative pancreatic fistula (CR-POPF), and biliary fistula (BF).
- Key pathogens identified were *K. pneumoniae* and *E. faecalis* in bile/drainage fluid, and *K. pneumoniae* and *S. haemolyticus* in bacteremia.
Conclusions:
- PBD, CR-POPF, and BF are significant independent risk factors for infectious complications post-PD.
- Minimizing PBD to select cases and reducing CR-POPF and BF incidence are essential for infection control.
- Continuous monitoring of bile and drainage fluid pathogens throughout hospitalization is recommended.
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