School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy Monza, Italy.
School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy Monza, Italy.
Nutrition. 2021 Jun;86:111184. doi: 10.1016/j.nut.2021.111184. Epub 2021 Jan 31.
Infectious morbidity is the most common and costly among all surgery-related complications, and infections by multidrug-resistant microorganisms (MDR) are associated with poor outcomes. Derangements of body composition is a recognized risk factor for infections. The aim of this study was to investigate the potential association between specific traits of body composition and the risk of having MDR-related infections.
This was a prospective study with patients scheduled for major abdominal surgery for gastrointestinal cancer. Bioimpedance vector analysis (BIVA), a reliable tool for body composition assessment, was performed the day before the operation. Postoperative complications were collected focusing on resistance patterns and site of infection. Patterns of resistance were compared with BIVA parameters.
Data from 182 patients suffering from pancreatic (n = 76, 41.7%), rectal (n = 38, 20.9%), gastric (n = 31, 17%), or hepatic (n = 37, 20.3%) malignancy were collected. Overall complications occurred in 108 patients (59%), and in 45 patients (28%) bacterial infections were proven at culture. Of these, 15 (8%) were multidrug-sensitive (MDS), 38 MDR, and 2 extended drug-resistant (XDR) infections. The standardized phase angle measured (SPA) at BIVA was significantly lower in the MDR/XDR infections (-0.02 ± 1.20) than for no infection/MDS (0.56 ± 1.53; P = 0.029). A multivariate analysis showed that SPA was the only independent variable for MDR/XDR infections with an odds ratio of 3.057 (95% confidence interval, 1.354-6903; P = 0.007). The predictive ability of SPA revealed an area under the receiver operating characteristic curve of 0.662, with an optimal threshold of -0.3.
In surgical cancer patients, preoperative value of SPA lower than -0.3 is associated with the outbreak of MDR bacterial infections.
感染发病率是所有与手术相关的并发症中最常见和最昂贵的，而多重耐药微生物（MDR）感染与不良预后相关。身体成分的紊乱是感染的一个公认的危险因素。本研究的目的是探讨身体成分的特定特征与发生 MDR 相关感染的风险之间的潜在关联。
这是一项前瞻性研究，纳入了因胃肠道癌症接受大型腹部手术的患者。手术前一天进行生物阻抗向量分析（BIVA），这是一种可靠的身体成分评估工具。收集术后并发症，重点关注耐药模式和感染部位。耐药模式与 BIVA 参数进行比较。
共收集了 182 名患有胰腺（n=76，41.7%）、直肠（n=38，20.9%）、胃（n=31，17%）或肝（n=37，20.3%）恶性肿瘤的患者的数据。108 名患者（59%）发生了总体并发症，45 名患者（28%）的细菌感染在培养中得到证实。其中，15 例（8%）为多药敏感（MDS），38 例为 MDR，2 例为扩展药物耐药（XDR）感染。BIVA 测量的标准化相位角（SPA）在 MDR/XDR 感染中明显较低（-0.02±1.20），而无感染/MDS 感染中则较高（0.56±1.53；P=0.029）。多变量分析显示，SPA 是 MDR/XDR 感染的唯一独立变量，其优势比为 3.057（95%置信区间，1.354-6903；P=0.007）。SPA 的预测能力显示，接受者操作特征曲线下面积为 0.662，最佳阈值为-0.3。
在接受手术的癌症患者中，术前 SPA 值低于-0.3 与 MDR 细菌感染的爆发有关。
