Aritake Tsukasa, Natsume Seiji, Asano Tomonari, Okuno Masataka, Itoh Naoya, Matsuo Keitaro, Ito Seiji, Komori Koji, Abe Tetsuya, Shimizu Yasuhiro
Department of Gastroenterological Surgery Aichi Cancer Center Hospital Nagoya Japan.
Division of Infectious Diseases Aichi Cancer Center Hospital Nagoya Japan.
Ann Gastroenterol Surg. 2024 Apr 22;8(5):888-895. doi: 10.1002/ags3.12801. eCollection 2024 Sep.
The aim of this study was to clarify the significance of blood culture testing in the postoperative period of pancreatoduodectomy (PD), a highly invasive surgery.
Rates of blood culture sampling and positivity were investigated for febrile episodes (FEs) in patients who underwent PD (2016-2021). FEs were defined as body temperature of 38.0°C or higher occurring on or after the 4th postoperative day. Fever origin was diagnosed retrospectively, and FEs were classified as pancreatic fistula (PF)-related or PF-unrelated FEs. Factors correlated with blood culture positivity were explored.
Among 339 patients who underwent PD, 99 experienced 202 FEs. Blood culture testing was performed on 160 FEs occurring in 89 patients. The sampling and positivity rates were 79.2% and 17.5%, respectively, per episode and 89.9% and 28.1%, respectively, per patient. Thirty-six FEs were classified as PF-related and 124 were classified as PF-unrelated FEs. The blood culture positivity rate was significantly lower in PF-related vs. PF-unrelated FEs (1/36 vs. 27/124, respectively, = 0.006). The blood culture positivity rate was significantly higher in patients with cholangitis, catheter-related blood stream infection, and urinary tract infection than PF-related FEs. Multivariate analysis showed that blood culture positivity was negatively associated with PF-related FEs and positively associated with accompanying symptoms of shivering, Pitt Bacteremia Score, and preoperative biliary drainage.
Patients who underwent PD showed relatively high blood culture positivity rates. Based on these results, it may be possible to distinguish PF-related and -unrelated FEs.
本研究旨在阐明血培养检测在胰十二指肠切除术（PD）术后阶段的意义，该手术具有高度侵袭性。
对接受PD手术（2016 - 2021年）患者的发热事件（FE）进行血培养采样率和阳性率调查。FE定义为术后第4天及以后出现的体温38.0°C或更高。回顾性诊断发热来源，FE分为与胰瘘（PF）相关或与PF无关的FE。探讨与血培养阳性相关的因素。
在339例接受PD手术的患者中，99例经历了202次FE。对89例患者出现的160次FE进行了血培养检测。每次发作的采样率和阳性率分别为79.2%和17.5%，每位患者分别为89.9%和28.1%。36次FE被分类为与PF相关，124次被分类为与PF无关的FE。与PF无关的FE相比，与PF相关的FE血培养阳性率显著更低（分别为1/36和27/124， = 0.006）。胆管炎、导管相关血流感染和尿路感染患者的血培养阳性率显著高于与PF相关的FE。多因素分析显示，血培养阳性与与PF相关的FE呈负相关，与寒战伴随症状、皮特菌血症评分和术前胆道引流呈正相关。
接受PD手术的患者血培养阳性率相对较高。基于这些结果，有可能区分与PF相关和无关的FE。
