Department of Infectious Diseases, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Mexico City, Mexico; School of Medicine, Universidad Panamericana, Augusto Rodin No. 498, Insurgentes Mixcoac, Benito Juárez, Mexico City, Mexico.
Department of Digestive Tube and Hepatopancreatobiliary Tumors, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Mexico City, Mexico.
Hepatobiliary Pancreat Dis Int. 2024 Oct;23(5):502-508. doi: 10.1016/j.hbpd.2023.04.004. Epub 2023 Apr 11.
Pancreaticoduodenectomy is the standard treatment for resectable periampullary cancer. Surgical site infections (SSI) are common complications with increased morbidity. The study aimed to describe the prevalence, risk factors, microbiology, and outcomes of SSI among patients undergoing pancreaticoduodenectomy.
We conducted a retrospective study in a referral cancer center between January 2015 and June 2021. We analyzed baseline patient characteristics and SSI occurrence. Culture results and susceptibility patterns were described. Multivariate logistic regression was used to determine risk factors, proportional hazards model to evaluate mortality, and Kaplan-Meier analysis to assess long-term survival.
A total of 219 patients were enrolled in the study; 101 (46%) developed SSI. Independent factors for SSI were diabetes mellitus, preoperative albumin level, biliary drainage, biliary prostheses, and clinically relevant postoperative pancreatic fistula. The main pathogens were Enterobacteria and Enterococci. Multidrug-resistance rate in SSI was high but not associated with increased mortality. Infected patients had higher odds of sepsis, longer hospital stay and intensive care unit stay, and readmission rate. Neither 30-day mortality nor long-term survival was significantly different between infected and non-infected patients.
SSI prevalence among patients undergoing pancreaticoduodenectomy was high and largely caused by resistant microorganisms. Most risk factors were related to preoperative instrumentation of the biliary tree. SSI was associated with greater risk of unfavorable outcomes; however, survival was unaffected.
胰十二指肠切除术是可切除的壶腹周围癌的标准治疗方法。手术部位感染（SSI）是常见的并发症，发病率增加。本研究旨在描述胰十二指肠切除术后患者 SSI 的发生率、危险因素、微生物学和结局。
我们在一家转诊癌症中心进行了一项回顾性研究，时间为 2015 年 1 月至 2021 年 6 月。我们分析了基线患者特征和 SSI 发生情况。描述了培养结果和药敏模式。采用多变量逻辑回归确定危险因素，比例风险模型评估死亡率，Kaplan-Meier 分析评估长期生存率。
共有 219 例患者纳入研究，101 例（46%）发生 SSI。SSI 的独立危险因素包括糖尿病、术前白蛋白水平、胆汁引流、胆道支架和临床相关的术后胰瘘。主要病原体为肠杆菌科和肠球菌。SSI 的耐药率较高，但与死亡率增加无关。感染患者发生脓毒症、住院时间和重症监护病房停留时间延长以及再入院率的可能性更高。感染和非感染患者的 30 天死亡率和长期生存率无显著差异。
胰十二指肠切除术后患者 SSI 的发生率较高，主要由耐药微生物引起。大多数危险因素与术前胆道器械操作有关。SSI 与不良结局的风险增加相关；然而，生存不受影响。
