Analysis for bacterium and Diagnosis and treatment of pancreatic fistula complicated with abdominal infection after pancreaticoduodenectomy

Abstract

Objective To Analysis for the drug resistance of pathogenic bacterium and study the methods of diagnosis and treatment of pancreatic fistula complicated with abdominal infection after pancreaticoduodenectomy.Methods We retrospectively analyzed the clinical data of 386 patients after pancreaticoduodenectomy from January 2010 to December 2012 in PLA General Hospital,84 cases were diagnosed of pancreatic fistula,and 32 cases were diagnosed of pancreatic fistula complicated with abdominal infection.The patient who was afraid of pancreatic fistula complicated with abdominal infection was diagnosed by examining funga in blood,fluid,and image examination (such as abdominal Bounce check or CT scan).Once who was diagnosis of pancreatic fistula complicated with abdominal infection would be treatment by puncture drainage and antibiotics.Results Fifty-three pathogenic strains were isolated from 32 patients,The 53 strains of pathogens included 41 strains of bacteria and 12 strains of fungus.Enterococcus faecalis infection was diagnosed in 23 strains (43.4％),Escherichia coli infection was diagnosed in 18 strains (40％),Staphylococcus aureus infection was diagnosed in 12strains (16.6％).The major bacteria were Enterococcus faecium (24.5 ％),Candida albicans (13.2％) and Coagulase-negative Staphylococcus (11.3％).And the major fungus was Candida albicans (7.5％).The pathogens had the character of multi-drug resistance.The most effective antibiotics to Gram negative bacillus was Cefoperazone/Shubatan.And the antibiotics to Gram positive cocci were Vancomycin and Teicoplanin.And the most effective antibiotics to fungus was Fluconazole.32 patients were cured by puncture drainage and antibiotics,and no one patient was dead.Conclusions Pancreatic fistula complicated with abdominal infection is one of the major complication after pancreaticoduodenectomy.And the pathogens had the character of multi-drug resistance.The key points of infection control were effective prevention and early treatment.Image examination and funga examination were the most important to the diagnose of pancreatic fistula complicated with abdominal infection.And the best therapy methods are puncture drainage and antibiotics. Key words: Pancreaticoduodenectomy ; Pancreatic fistula; Infection ; Pathogenic bacteria; Drug resistance ; Diagnosis ; Treatment outcome