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Characterization and impact of wound infection after pancreas transplantation
J E Everett1, D C Wahoff, C Statz
1Division of Surgical Infectious Disease, University of Minnesota, Minneapolis.
Objective:
To characterize the incidence, microbial pathogenesis, risk factors, and impact of wound infection after pancreas transplantation.
Design:
Retrospective analysis.
Setting:
A large university hospital.
Patients:
From January 1, 1990, to September 30, 1993, 197 patients underwent 207 consecutive pancreas transplantation procedures.
Main Outcome Measures:
Wound infection and patient and allograft survival rates at 1 year.
Results:
Sixty-nine patients (33%) suffered wound infections: 21 (10%) were superficial; 31 (15%), deep; and 17 (8%), combined. Most (74%) wound infections were monomicrobial. Staphylococcus epidermidis and Candida species were the most common pathogens. Prolonged operating time, older donors, and enteric drainage were associated with higher wound infection rates. Deep and combined wound infections led to allograft loss despite subsequent salvage procedures. Combined wound infection was associated with significantly higher mortality.
Conclusions:
A deep wound infection should be an indication for allograft removal. Antifungal prophylaxis, stringent donor criteria, and delayed primary wound closure should lower the incidence of wound infection.