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Surgical site infection following pancreaticoduodenectomy in a referral cancer center in Mexico

Hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 502-508页

作者： rodrigo villaseñor-echavarri Javier Melchor-Ruan Mercedes Aranda-Audelo Gabriela Arredondo-Saldaña Patricia Volkow-Fernandez Maria del Carmen Manzano-Robleda Alejandro E Padilla-Rosciano Diana Vilar-Compte Department of Infectious Diseases Instituto Nacional de CancerologíaAv.San Fernando 22Belisario Domínguez Secc 16TlalpanMexico CityMexico School of Medicine Universidad PanamericanaAugusto Rodin No.498Insurgentes MixcoacBenito JuárezMexico CityMexico Department of Digestive Tube and Hepatopancreatobiliary Tumors Instituto Nacional de CancerologíaAv.San Fernando 22Belisario Domínguez Secc 16TlalpanMexico CityMexico Department of Infectious Diseases Hospital Manuel Gea GonzálezCalz.de Tlalpan 4800Belisario Domínguez Secc 16TlalpanMexico CityMexico Gastrointestinal and Endoscopy Department Instituto Nacional de CancerologíaAv.San Fernando 22Belisario Domínguez Secc 16TlalpanMexico CityMexico

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

关键词： Surgical site infection Pancreaticoduodenectomy Pancreatic cancer Endoscopic biliary drainage Biliary prosthesis

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