The Occurrence of Klebsiella pneumoniae in Drainage Fluid After Pancreaticoduodenectomy: Risk Factors and Clinical Impacts

Yang, Yifei; Xu, Feifei; Cai, Zhenning; Qiu, Yudong; Mao, Liang

doi:10.3389/fmicb.2021.763296

Cited by 6 publications

(12 citation statements)

References 33 publications

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“…In our study, 54.3% of the patients were jaundiced and 65% of them received preoperative biliary drainage, undoubtedly contributing to the high postoperative SSI rate. Significantly, K. pneumoniae and E. faecalis were frequently found in postoperative ascites and bile in the Fu study, and we further confirmed these findings in our earlier research that positive bacteria cultures, particularly K. pneumoniae, were closely related to CR-POPF and serious complications [22].…”

Section: Discussionsupporting

confidence: 90%

“…7 [34.8-39.4] g/L vs. 38.4 [36.4-40.5] g/L; p = 0.013) and higher CRP level (6.5 [4.2-34.6] g/L vs. 4.7 [2.9-9.8] g/L; p = 0.007) (Table 3). The incidences of CR-POPF (53.2% vs. 31.7%; p = 0.016), major complications (36.2% vs. 4.8%; p = 0.001), PLOS (22 [17-33] d vs. 17 [14][15][16][17][18][19][20][21][22][23] d; p = 0.002), and CCI score (34.8 [24.2-39.2] vs. 25.7 [19.4-32]; p = 0.001) were all increased in sarcopenic patients. Significant sex differences were found in the visceral obesity group (33 men vs. 5 women; p = 0.001) and the BMI was higher (26.1 ± 3.5 kg/m 2 vs. 22.1 ± 2.4 kg/m 2 ; p = 0.001).…”

Section: Relations Between Clinical Characteristics and Body Morphome...mentioning

confidence: 99%

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Predictive Value of Body Composition Parameters for Postoperative Complications in Patients Who Received Pancreaticoduodenectomy

et al. 2023

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Introduction Sarcopenia and visceral obesity have been identified as risk factors for postoperative complications following hepatobiliary and colon surgery. However, the correlation between body composition parameters and morbidity following pancreatectomy remains unclear. This study aimed to assess the predictive value of body composition parameters measured from preoperative CT images for postoperative complications following pancreaticoduodenectomy(PD). Methods A retrospective study of patients who underwent PD between January 2018 and January 2021 was performed. Areas of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), total abdominal muscle area (TAMA) and mean muscle radio-attenuation were measured from preoperative CT images. Postoperative complications were categorized according to the Clavien-Dindo classification (CDC) and comprehensive complication index (CCI) scores were calculated. Logistic regression analysis was performed to identify factors associated with clinically relevant postoperative pancreatic fistula (CR-POPF) and high CCI score (≥26.2). Results From the data collected on 129 study patients, sarcopenia, visceral obesity and myosteatosis were detected in 47 (36.4%), 38 (29.4%), and 50 (38.7%) patients, respectively. CR-POPF developed in 51(39.5%) patients, the overall median CCI score was 30.8 (22.6-36.2), and high CCI scores were identified in 70 (54.3%) patients. Multivariate analysis indicated sarcopenia and visceral obesity were independent risk variables for CR-POPF. Preoperative sarcopenia, visceral obesity, age, preoperative biliary drainage, and a positive culture of postoperative drainage were predictors of high CCI scores. Conclusion Sarcopenia and visceral obesity were significant predictors of CR-POPF and high CCI score. Preoperative body composition assessment by CT images may help to identify high-risk patients who undergo PD.

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Section: Discussionsupporting

confidence: 90%

Section: Relations Between Clinical Characteristics and Body Morphome...mentioning

confidence: 99%

Predictive Value of Body Composition Parameters for Postoperative Complications in Patients Who Received Pancreaticoduodenectomy

et al. 2023

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“…Given that organ/space SSI is the most frequent cause of postoperative complications, which may trigger subsequent events such as CR-POPF, sepsis, readmission or even death, this retrospective study's ndings are notable. As we reported previously and showed in this study, PBD was substantially corelate with postoperative infectious complications especially organ/space SSI [2,11,19]. This invasive operation destroys the function of Oddi's sphincter, increase the contamination of surgical eld with bile which may contain microbes resistant to ceftriaxone after the resection of common bile duct [20,21].…”

Section: Discussionsupporting

confidence: 62%

“…This speculation is supported indirectly by the fact that a number of studies had demonstrated that speci c antibiotic based on bile culture was effective on reducing the incidence of organ/space SSI[26-28]. We identi ed K. pneumoniae had negative impacts on organ/space SSI, major complications, CR-POPF based on past research [11]. The study focused on the anastomoses of the digestive tract had implicated collagenase-producing pathogens, such as Enterococcus, in the formation of anastomotic leakage which may result in subsequent organ/space SSI [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic prophylaxis with piperacillin–tazobactam reduces organ/space surgical site infection after pancreaticoduodenectomy: A retrospective and propensity score-matched analysis

Yang,

Sheng,

Cai

et al. 2023

Preprint

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Background The occurrence of surgical site infection (SSI) after pancreaticoduodenectomy (PD) is still relatively high. The aim of this retrospective study is to evaluate the efficacy of piperacillin-tazobactam as perioperative prophylactic antibiotic on organ/space SSI for patients underwent PD. Methods 407 consecutive patients who underwent PD between January 2018 and December 2022 were enrolled and analyzed retrospectively. The univariate and multivariate analysis were used to identify independent risk factors of organ/space SSI. Postoperative complications were compared between the two groups according to the use of prophylactic antibiotics by a ratio of 1:1 propensity score-matched (PSM) analysis. Results Based on perioperative prophylactic antibiotic use, all 407 patients were divided into the ceftriaxone group (n = 192, 47.2%) and piperacillin–tazobactam group (n = 215, 52.8%). The rate of organ/space SSI was 31.2% with the choice of perioperative antibiotics (OR = 2.837, 95%CI = 1.802–4.465, P < 0.01) as one of independent risk factors. After PSM, there were similar baseline characteristics among the groups. Meanwhile, the piperacillin–tazobactam group had a significant lower rate of organ/space SSI (P < 0.05) compared to the ceftriaxone group both before and after PSM. Conclusions The adoption of piperacillin–tazobactam as perioperative prophylaxis for patients underwent PD reduced organ/space SSI significantly.

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The clinical significance of intraoperative lavage fluid culture during pancreaticoduodenectomy on organ/space surgical site infection

Yang,

Sheng,

et al. 2024

Sci Rep

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Organ/space surgical site infection (SSI) are common after pancreaticoduodenectomy (PD). There is limited research on the clinical impact of intraoperative lavage fluid contamination in patients undergoing PD. One hundred five patients who underwent PD between August 2022 and July 2023 were retrospectively enrolled. The intraoperative bile and peritoneal lavage were collected for bacterial culture. Postoperative drainage bacterial cultures were performed every 2–3 days thereafter until drains were all removed. The bacteria isolated from intraoperative lavage fluid, intraoperative bile, and postoperative drainage fluid were examined in detail. The risk factors associated with positive intraoperative lavage fluid culture were analyzed through both univariate and multivariate analyses. Organ/space SSI occurred in 59(56.2%) of the 105 patients. The positivity rates of cultures in intraoperative lavage fluid, intraoperative bile, and postoperative drainage fluid were found to be 41.0%, 67.6%, and 84.8%, respectively. Patients with positive intraoperative lavage fluid culture had a significantly higher occurrence of organ/space SSI compared to the negative group (69.0% vs. 29.4%, P < 0.001). Preoperative biliary drainage (PBD) was identified as the only independent risk factor for the contamination of intraoperative lavage fluid (OR = 7.687, 95% CI: 2.164–27.300, P = 0.002). K. pneumoniae was the most common isolates both in the intraoperative lavage fluid and postoperative drainage fluid. Intraoperative lavage fluid contamination closely correlated with organ/space SSI after PD. Meanwhile, PBD was the only risk factor for the contamination of intraoperative lavage fluid.

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The Occurrence of Klebsiella pneumoniae in Drainage Fluid After Pancreaticoduodenectomy: Risk Factors and Clinical Impacts

Cited by 6 publications

References 33 publications

Predictive Value of Body Composition Parameters for Postoperative Complications in Patients Who Received Pancreaticoduodenectomy

Predictive Value of Body Composition Parameters for Postoperative Complications in Patients Who Received Pancreaticoduodenectomy

Antibiotic prophylaxis with piperacillin–tazobactam reduces organ/space surgical site infection after pancreaticoduodenectomy: A retrospective and propensity score-matched analysis

The clinical significance of intraoperative lavage fluid culture during pancreaticoduodenectomy on organ/space surgical site infection

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