耐甲氧西林金黄色葡萄球菌（MRSA）感染对胰十二指肠切除术（PD）后患者预后的影响——是否值得关注？

Impact of methicillin-resistant Staphylococcus Aureus (MRSA) infection on patient outcome after pancreatoduodenectomy (PD)--a cause for concern?

机构信息

Department of Hepatobiliary Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, UK.

出版信息

Pancreas. 2010 Nov;39(8):1211-4. doi: 10.1097/MPA.0b013e3181e00cad.

DOI:10.1097/MPA.0b013e3181e00cad

PMID:20944489

Abstract

OBJECTIVES

This study evaluated the impact of methicillin-resistant Staphylococcus aureus (MRSA) hospital-acquired infection on postoperative complications and patient outcome after pancreatoduodenectomy (PD).

METHODS

Seventy-nine patients who underwent PD were monitored for hospital-acquired MRSA. The patients were grouped as (1) no MRSA infection, (2) skin colonization with MRSA, and (3) systemic MRSA infection.

RESULTS

Forty (51%) of the 79 patients were MRSA positive during hospital admission. Fourteen of the 40 patients swabbed for MRSA were found positive (skin colonization), and 26 patients (33%) developed systemic MRSA infection after PD. The sites of MRSA infection included (1) abdominal drain fluid (16/26; 42%), (2) sputum (4/26; 15%), (3) blood cultures (2/26; 8%), and (4) combination of sites (9/26; 35%). The patients with systemic MRSA infection had a longer postoperative stay (31 vs 22 days; P = 0.005) and increased incidence of chest infections compared with MRSA-negative patients (14 vs 4; P = 0.02). Four of the 16 patients with MRSA-positive drain fluid had a postpancreatectomy hemorrhage compared with 3 of the 63 patients with no MRSA infection in drain fluid (P = 0.02).

CONCLUSION

Of the 79 patients admitted for PD, 51% became colonized with MRSA infection. Systemic hospital-acquired MRSA infection in 33% was associated with prolonged postoperative stay, increased wound and chest infections, and increased risk of postoperative hemorrhage.

摘要

目的

本研究评估了耐甲氧西林金黄色葡萄球菌（MRSA）医院获得性感染对胰十二指肠切除术（PD）后患者术后并发症和结局的影响。

方法

对 79 例行 PD 的患者进行了医院获得性 MRSA 监测。将患者分为（1）无 MRSA 感染，（2）MRSA 皮肤定植，和（3）全身性 MRSA 感染。

结果

79 例患者中有 40 例（51%）在住院期间 MRSA 检测呈阳性。40 例 MRSA 拭子阳性的患者中，有 14 例（皮肤定植），26 例（33%）在 PD 后发生了全身性 MRSA 感染。MRSA 感染部位包括（1）腹腔引流液（16/26；42%），（2）痰（4/26；15%），（3）血培养（2/26；8%）和（4）混合部位（9/26；35%）。与 MRSA 阴性患者相比，全身性 MRSA 感染患者的术后住院时间更长（31 天 vs 22 天；P = 0.005），胸部感染发生率更高（14 例 vs 4 例；P = 0.02）。16 例 MRSA 阳性引流液患者中有 4 例发生胰切除术后出血，而 63 例无 MRSA 感染引流液的患者中有 3 例发生胰切除术后出血（P = 0.02）。