Development Of Intra-abdominal Infection Research Articles

Blood loss during HPB procedures.

During the last decades, simultaneously with the development of surgical technique, modern equipment and perioperative management, there has been a significant improvement in postoperative outcome. Despite this, infectious complications and perioperative bleeding remain the leading causes of postoperative morbidity and mortality in HPB surgery. We conducted a retrospective study over a three-year period in 256 patients who underwent surgery of the pancreas, liver, gallbladder, or bile ducts. We monitored perioperative blood loss, the number of administered transfusions, the type and severity of postoperative complications, the number of reoperations and the number of readmissions. The average blood loss was 457 ml. We administered transfusions to 39 patients (17%). We confirmed the hypothesis that the presence of blood loss statistically significantly increases the development of deep intra-abdominal infections (p=0.0188). Morbidity increases with increasing blood loss (p=0.0168). We confirmed a statistically significant difference in the blood loss between the groups with and without complications (p=0.001). Postoperative 30-day mortality was less than 1% (n=2). There were 15 (6%) reoperated patients, seven for acute bleeding and eight for infectious complications. The length of hospital stay was statistically significantly longer in patients who received transfusions - erythrocytes (p=0.023), and plasma (p=0.011). We readmitted 12 patients, three patients died during rehospitalization (the 90-day mortality rate was 2%, n=5). A total of 59% patients in our group were classified as ASA III. With increasing blood loss, morbidity (development of intra-abdominal infections) increases significantly, but despite this, overall post- operative mortality remains low. Early postoperative bleeding is the cause of more than half of reoperations. The length of hospitalization increases significantly with the number of transfusions administered.

Temporary Abdominal Closure Is Associated with Increased Risk for Fungal Intra-Abdominal Infections in Trauma Patients.

Background: Fungal infections are associated with increased morbidity and death. Few studies have examined risk factors associated with post-operative fungal intra-abdominal infections (FIAIs) in trauma patients after exploratory laparotomy. In this study, we evaluated potential risk factors for acquiring post-operative FIAIs and their impact on clinical outcomes. Methods: This was a retrospective analysis of trauma patients admitted from 2005 to 2018 who underwent exploratory laparotomy and subsequently had development of intra-abdominal infection (IAI). Demographics, comorbidities, culture data, antimicrobial usage, Injury Severity Scores (ISS), and clinical outcomes were abstracted. All post-operative IAIs were evaluated and stratified as either bacterial, fungal, combined, and with or without colonization. All groups were compared. Risk factors for the development of post-operative IAI and clinical outcomes were analyzed by Student t test and chi-square test. Multi-variable logistic regression was used to determine independent predictors of post-operative FIAIs. Results: There were 1675 patients identified as having undergone exploratory laparotomy in the setting of traumatic injury, 161 of whom were suspected of having IAI. A total of 105 (6.2%) patients had a diagnosis of IAI. Of these patients, 40 (38%) received a diagnosis of FIAI. The most common fungal pathogens were unspeciated yeast (48.3%), followed by Candida albicans (42.7%), C. glabrata (4.5%), C. dubliniensis (2.25%), and C. tropicalis (2.25%). There were no significant differences in demographics, comorbidities, and percentage of gastric perforations between FIAI and bacterial IAI (BIAI) groups. Patients with FIAIs, however, had a 75% temporary abdominal closure (TAC) rate compared with 51% in BIAIs (p = 0.01). The FIAI group had higher ISS (27 vs. 22, p = 0.03), longer hospital days (34 vs. 25, p = 0.02), and longer intensive care unit (ICU) days (17 vs. 9, p = 0.006) when compared with BIAI. The FIAI group also had a five-fold greater mortality rate. Logistic regression identified TAC as an independent risk factor for the development of post-operative FIAIs (odds ratio [OR] 6.16, confidence interval [CI] 1.14-28.0, p = 0.02). Conclusions: An FIAI after exploratory laparotomy was associated with greater morbidity and death. A TAC was associated independently with increased risk of FIAI after exploratory laparotomy in the setting of traumatic injury. Clinicians should suspect fungal infections in trauma patients in whom post-operative IAI develops after undergoing exploratory laparotomy using TAC techniques.

Does Intra-Abdominal Infection after Curative Gastrectomy Affect Patients' Long-Term Prognosis? A Multi-Center Study Based on a Large Sample Size.

Background: The objective of the study was to investigate the effects of intra-abdominal infection after curative gastrectomy on the prognosis of patients. Patients and Methods: Data were collected for enrolled patients who underwent curative gastrectomy in two centers; the relationship between intra-abdominal infection and prognosis was analyzed. Results: Of the 5,721 patients in the entire group, intra-abdominal infection occurred in 202 (3.5%) patients. Co-morbidities and duration of surgical procedures ≥240 minutes represented the independent risk factors for intra-abdominal infection. The overall five-year survival of patients with and without intra-abdominal infection was 60.2% and 64.3%, respectively (p = 0.041). After propensity score matching, the five-year overall survival between the two groups was not significantly different (p = 0.909). T staging, N staging, American Society of Anesthesiologists score, and age were independent prognostic factors for the overall survival of patients who underwent curative gastrectomy. The meta-analysis of the random effects model showed that there were no significant differences in the five-year overall survival between patients with and without intra-abdominal infection. Conclusions: The development of intra-abdominal infection after curative gastrectomy is associated closely with co-morbidities and longer operation time, whereas intra-abdominal infection does not lead to reduced long-term survival of patients.

Association between matrix metallopeptidase-9 rs3918242 locus single nucleotide polymorphisms and intra-abdominal infection after pancreaticoduodenectomy

Objective To investigate the association between matrix metallopeptidase-9 (MMP-9) rs3918242 locus single nucleotide polymorphisms and intra-abdominal infection after pancreaticoduodenectomy. Methods 152 patients undergoing pancreaticoduodenectomy were enrolled, and the association between 21 factors including MMP-9 rs3918242 polymorphisms and intra-abdominal infection after pancreaticoduodenectomy was analyzed using Logistic regression method. Postoperative plasma MMP-9 levels were compared between different groups. Results Univariate analysis revealed pancreatic duct diameter ≥3 mm [odds ratio (OR)=0.378, 95% confidence interval (CI): 0.163, 0.874, P=0.023], pancreatic texture (soft, OR=3.414, 95% CI: 1.353, 8.612, P=0.009), operative time ≥6 h (OR=3.018, 95% CI: 1.302, 6.991, P=0.010), pancreatic fistula (OR=6.615, 95% CI: 2.708, 16.161, P=0.000), postoperative intra-abdominal bleeding (OR=8.768, 95% CI: 1.958, 39.264, P=0.005), and rs3918242 polymorphisms CT/TT genotypes (OR=0.211, 95% CI: 0.060, 0.737, P=0.015) were associated with intra-abdominal infection after pancreaticoduodenectomy. Operative time ≥6 h (OR=4.181, 95% CI: 1.535, 11.384, P=0.005), pancreatic fistula (OR=9.713, 95% CI: 3.507, 26.900, P=0.000), and rs3918242 polymorphisms CT/TT genotypes (OR=0.166, 95% CI: 0.042, 0.646, P=0.010) were associated with intra-abdominal infection after pancreaticoduodenectomy in multivariate analysis. The patients carrying rs3918242 CT/TT genotypes [(275.2±103.9) ng/ml] had higher postoperative plasma MMP-9 levels than those carrying CC genotype [(240.1±85.2) ng/ml, P=0.005]. Meanwhile, the patients with intra-abdominal infection [(205.6±83.1) ng/ml] had lower postoperative plasma MMP-9 levels than those without intra-abdominal infection [(258.5±82.4) ng/ml, P=0.000]. Conclusion Operative time, pancreatic fistula, and rs3918242 polymorphisms were the independent influential factors of intra-abdominal infection after pancreaticoduodenectomy. Lower postoperative plasma MMP-9 levels may contribute to the development of intra-abdominal infection. Key words: Matrix metalloproteinase-9; Single nucleotide polymorphisms; Intra-abdominal infection; Pancreaticoduodenectomy; Pancreatic fistula

Post-Operative Antibiotics after Appendectomy and Post-Operative Abscess Development: A Retrospective Analysis

Appendectomy is one of the most common emergency operations. Prophylaxis against infective complications involves post-operative antibiotics. There is no consensus as to the optimum antibiotic regimen. This study aimed to assess the relation between the duration of the post-operative antibiotic administration and intra-abdominal infections (IAIs). All patients who underwent appendectomy between September 1, 2009, and August 31, 2010, were identified. The appearance of the appendix at operation, post-operative antibiotics, white blood cell count, and temperature at the time of conversion of intravenous (IV) to oral antibiotics were compiled. IAIs were assessed as the final outcome. Two hundred sixty six patients underwent appendectomy-188 for simple appendicitis and 78 for complicated appendicitis. There were 18 IAIs (6.8%) overall, 10 (12.8%) after complicated appendicitis and eight (4.2%) after simple appendicitis. Prolonging antibiotics beyond the operation in the simple appendicitis group did not alter the incidence of IAI. Similarly, in the complicated appendicitis group, prolonging antibiotics beyond five days did not alter the incidence of IAI. Furthermore, in patients with complicated appendicitis, the presence of leukocytosis, fever, or both when IV antibiotics were converted to oral drugs was associated with the development of IAI (p=0.013). In simple appendicitis, post-operative antibiotics may not be beneficial at all. In complicated appendicitis, prolonging the course of antibiotics was not associated with a reduced IAI rate. However, cessation of IV antibiotics when fever or leukocytosis was present was associated with IAI development.

Intra-abdominal infections after simultaneous pancreas – kidney transplantation

Intra-abdominal infections (IAI) are among the most common causes of pancreatic graft loss and recipient death in the early period after simultaneous pancreas - kidney transplantation (SPK). The aim of the study was to analyze risk factors and clinical consequences of IAI in SPK patients. Forty-six consecutive SPK performed from 2004 to 2010 were subjected to analysis. IAI developed in 10 recipients (21.7%). The group of recipients with IAI had a higher rate of patients that required transfusion of more than 2 blood units (90% vs. 47%, p=0.028) or relaparotomy (80% vs. 14%, p<0.001), in comparison with patients without IAI. Additionally, in patients with IAI, both delayed kidney graft function or primary kidney graft nonfunction (40% vs. 11%, p=0.001) and recipient death (40% vs. 3%, p=0.006) were more frequently observed. Logistic regression analysis revealed an increased risk of IAI development in patients who required early relaparotomy (OR=24.8, p<0.001), transfusion of more than 2 blood units (OR=12.6, p=0.02), or postoperative dialysis therapy (OR=14.1, p=0.003). Perioperative blood loss requiring transfusion and necessity of relaparotomy increase the risk of IAI after SPK. Development of IAI after SPK may result in impaired kidney graft function and increases patient mortality in the early postoperative period.