Shinagawa N, Hisada M, Ishihara H, Suzui K, Hori K, Mashita K, Hanai T, Ishikawa S, Yura J
First Department of Surgery, Nagoya City University Medical School, Japan.
Gan To Kagaku Ryoho. 1992 Feb;19(2):173-7.
Postoperative infection occurs more frequently in patients with malignant disease than in patients with benign disease. Postoperative infection control in patients with hepatic cancer, biliary tract cancer and pancreatic cancer is studied. Although in patients with jaundice due to malignancy the rate of positive bacterial culture of the bile collected at the time of PTCD was low, the rate of positive bile culture increased after 10 to 14 days of PTCD. The predominant strain was Enterococcus spp., followed by Klebsiella spp., Enterobacter spp. and E. coli in that order. These bacteria isolated from the bile were considered to be causative organisms of postoperative infection. Prophylactic antibiotics after the operation for jaundice due to malignancy should be chosen based on the results of bile culture. In patients undergoing hepatectomy, which is considered to be an aseptic operation, gram positive cocci such as S. aureus was the most frequently encountered organism. On the other hand, in patients undergoing hepatectomy and intestinal anastomosis, enteric bacteria were frequently isolated from the infectious foci. In this study there were 6 cases of methicillin-resistant S. aureus (MRSA) postoperative infection, 3 cases after pancreatoduodenectomy, and 3 cases after hepatectomy. Even after an aseptic operation, postoperative MRSA infection is likely to occur in patients undergoing a more invasive operation, so hospital infection control should be again emphasized.
恶性疾病患者术后感染的发生率高于良性疾病患者。对肝癌、胆管癌和胰腺癌患者的术后感染控制进行了研究。尽管在因恶性肿瘤导致黄疸的患者中，经皮经肝胆道引流（PTCD）时采集的胆汁细菌培养阳性率较低，但PTCD 10至14天后胆汁培养阳性率增加。优势菌株依次为肠球菌属、克雷伯菌属、肠杆菌属和大肠杆菌。从胆汁中分离出的这些细菌被认为是术后感染的病原体。对于因恶性肿瘤导致黄疸的患者，术后预防性抗生素应根据胆汁培养结果选择。在被认为是无菌手术的肝切除术中，金黄色葡萄球菌等革兰氏阳性球菌是最常遇到的病原体。另一方面，在进行肝切除和肠道吻合术的患者中，肠道细菌经常从感染灶中分离出来。本研究中有6例耐甲氧西林金黄色葡萄球菌（MRSA）术后感染，胰十二指肠切除术后3例，肝切除术后3例。即使是无菌手术后，接受侵入性更大手术的患者仍可能发生术后MRSA感染，因此应再次强调医院感染控制。
