抗生素耐药模式增加对癌症胰切除术结果的影响。

Consequences of Increases in Antibiotic Resistance Pattern on Outcome of Pancreatic Resection for Cancer.

机构信息

Department of Surgery, San Gerardo Hospital, School of Medicine and Surgery, Milano-Bicocca University, Via Pergolesi 33, 20900, Monza, Italy.

Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy.

出版信息

J Gastrointest Surg. 2017 Oct;21(10):1650-1657. doi: 10.1007/s11605-017-3483-1. Epub 2017 Jul 5.

DOI:10.1007/s11605-017-3483-1

PMID:28681215

Abstract

BACKGROUND

The role of drug-resistance infections on surgical outcomes is controversial. The aim of the study was to determine whether increase antibiotic resistance was an independent risk factor for development of major non-infectious postoperative complications.

METHODS

This work included a multicenter cohort study of patients who underwent pancreatic resections for cancer over a 3-year interval. The primary outcome was major non-infectious complication rate developing after the occurrence of multi-drug sensitive (MDS) infection, multi-drug-resistant infection (MDR), and extensive drug-resistant (XDR) infection. Multivariate logistic regression models were used to adjust for patient and operative effects.

RESULTS

Eligible patients (517) were selected for the analysis. One hundred and thirteen (21.8%) patients had major non-infectious complications with a rate of 12.9% in the no infection group, 29.3% in the MSD, 41.5% in the MDR, and 58.8% in the XDR (p < 0.001). The median time of infection occurrence was postoperative days 4 (2-7 IQR) and 7 (3-12 IQR) non-infectious complications. At multivariate analysis, the risk of having major non-infectious complications was 2.67 (95% CI 1.24-5.77, P = 0.012) for MDR, 5.04 (95% CI 2.35-10.80, P < 0.001) for MDR, and 9.64 (95% CI 2.71-34.28, P < 0.001) for XDR.

CONCLUSION

Antimicrobial resistance is significantly associated with the risk of major non-infectious morbidity.

摘要

背景

耐药感染对手术结果的影响存在争议。本研究旨在确定抗生素耐药性增加是否是发生主要非感染性术后并发症的独立危险因素。

方法

本研究纳入了一项为期 3 年的多中心队列研究，研究对象为接受胰腺切除术治疗癌症的患者。主要结局是在发生多药敏感（MDS）感染、多药耐药（MDR）感染和广泛耐药（XDR）感染后发生的主要非感染性并发症发生率。采用多变量逻辑回归模型调整患者和手术效果。

结果

符合条件的患者（517 例）被纳入分析。113 例（21.8%）患者发生主要非感染性并发症，无感染组的并发症发生率为 12.9%，MDS 组为 29.3%，MDR 组为 41.5%，XDR 组为 58.8%（p<0.001）。感染发生的中位时间为术后第 4 天（2-7 IQR）和第 7 天（3-12 IQR）出现非感染性并发症。多变量分析显示，MDR 的主要非感染性并发症风险为 2.67（95%CI 1.24-5.77，P=0.012），MDR 的风险为 5.04（95%CI 2.35-10.80，P<0.001），XDR 的风险为 9.64（95%CI 2.71-34.28，P<0.001）。