Department of Surgery, University of Chicago Medical Center, Transplantation Institute, 5841 S. Maryland Ave. MC5027, Room J-517, Chicago, IL, 60637, USA.
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
J Gastrointest Surg. 2019 Nov;23(11):2201-2210. doi: 10.1007/s11605-019-04118-y. Epub 2019 Feb 4.
We assessed whether positive microbiological cultures from the islet preparation had any effect on the risk of infectious complications (IC) after total pancreatectomy with islet autotransplantation (TPIAT) in our center.
We analyzed preservation fluid and final islet product surveillance cultures with reference to clinical data of patients undergoing TPIAT. All patients received routine prophylactic broad-spectrum antibiotics.
The study involved 10 men and 18 women with a median age of 39 years. Over 30% of surveillance cultures during pancreas processing grew bacterial strains with predominantly polymicrobial contaminations (13 of 22 (59%)). At least one positive culture was identified in almost half of the patients (46%) undergoing TPIAT and a third had both surveillance cultures positive. Infectious complications affected 50% of patients. After excluding cases of PICC line-associated bacteremia/fungemia present on admission, incidence of IC was higher in cases of positive final islet product culture than in those with negative result (57% vs. 21%), which also corresponded with the duration of chronic pancreatitis (p = 0.04). Surgical site infections were the most common IC, followed by fever of unknown origin. There was no concordance between pathogens isolated from the pancreas and those identified during the infection.
While IC was common among TPIAT patients, we found no concordance between pathogens isolated from the pancreas and those identified during infection. Contamination of the final islet product was of clinical importance and could represent a surrogate marker for higher susceptibility to infection.
我们评估了胰岛制备物中阳性微生物培养物是否会对我们中心行全胰切除伴胰岛自体移植（TPIAT）后感染性并发症（IC）的风险产生影响。
我们分析了保存液和最终胰岛产品的培养物，同时参考了行 TPIAT 的患者的临床数据。所有患者均接受常规预防性广谱抗生素治疗。
本研究纳入了 10 名男性和 18 名女性，中位年龄为 39 岁。在胰腺处理过程中，超过 30%的监测培养物中生长出细菌菌株，主要为多种微生物污染（22 个中有 13 个（59%））。将近一半（46%）接受 TPIAT 的患者至少有一次阳性培养物，三分之一的患者两种监测培养物均为阳性。感染性并发症影响了 50%的患者。排除入院时存在的 PICC 相关菌血症/真菌血症后，最终胰岛产品培养阳性患者的 IC 发生率高于培养阴性患者（57%比 21%），且与慢性胰腺炎的持续时间相关（p=0.04）。手术部位感染是最常见的 IC，其次是不明原因发热。从胰腺中分离出的病原体与感染期间鉴定出的病原体之间没有一致性。
尽管 TPIAT 患者中 IC 很常见，但我们未发现从胰腺中分离出的病原体与感染期间鉴定出的病原体之间存在一致性。最终胰岛产品的污染具有临床意义，可能代表对感染更高的易感性的替代标志物。
