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Preoperative blood markers and intra-abdominal infection after colorectal cancer resection

World Journal of Gastrointestinal Surgery 2024年第2期16卷 451-462页

作者： Chang-Qing Liu Zhong-Bei Yu Jin-Xian Gan Tian-Ming Mei Department of Gastrointestinal Anorectal Surgery Suzhou Hospital Affiliated to Anhui Medical UniversitySuzhou 234000Anhui ProvinceChina

BACKGROUND Colorectal cancer(CRC)has one of the highest morbidity and mortality rates among digestive tract tumors.intra-abdominal infection(IAI)is a common postoperative complication that affects the clinical outcomes of patients with CRC and hinders their rehabilitation process.However,the factors influencing abdominal infection after CRC surgery remain unclear;further,prediction models are rarely used to analyze preoperative laboratory indicators and postoperative complications.AIM To explore the predictive value of preoperative blood markers for IAI after radical resection of CRC.METHODS The data of 80 patients who underwent radical resection of CRC in the Anorectal Surgery Department of Suzhou Hospital affiliated with Anhui Medical University were analyzed.These patients were categorized into IAI(n=15)and non-IAI groups(n=65)based on whether IAI occurred.Influencing factors were compared;general data and laboratory indices of both groups were identified.The relationship between the indicators was assessed.Further,a nomogram prediction model was developed and evaluated;its utility and clinical applic-ability were assessed.RESULTS The risk factors for IAI after radical resection of CRC were neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),and carcinoembryonic antigen(CEA)levels.NLR was correlated with PLR and SII(r=0.604,0.925,and 0.305,respectively),while PLR was correlated with SII(r=0.787).The nomogram prediction model demonstrated an area under the curve of 0.968[95%confidence interval(CI):0.948-0.988]in the training set(n=60)and 0.926(95%CI:0.906-0.980)in the validation set(n=20).The average absolute errors of the calibration curves for the training and validation sets were 0.032 and 0.048,respectively,indicating a good model fit.The decision curve analysis curves demonstrated high net income above the 5%threshold,indicating the clinical practicality of the model.CONCLUSION The nomogram model constructed using NLR,PLR,SII,and CEA levels had good accur

关键词： Radical resection of colorectal cancer Inflammatory factors intra-abdominal infection Predictive model Blood markers

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Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection

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Journal of Intensive Medicine 2024年第1期4卷 81-93页

作者： Marie Dejonckheere Massimo Antonelli Kostoula Arvaniti Koen Blot Ben CreaghBrown Dylan Wde Lange Jan De Waele Mieke Deschepper Yalim Dikmen George Dimopoulos Christian Eckmann Guy Francois Massimo Girardis Despoina Koulenti Sonia Labeau Jeffrey Lipman Fernando Lipovestky Emilio Maseda Philippe Montravers Adam Mikstacki JoseArtur Paiva Cecilia Pereyra Jordi Rello JeanFrancois Timsit Dirk Vogelaers Stijn Blot the abdominal Sepsis Study(AbSeS)group on behalf of the Trials Group of the European Society of Intensive Care Medicine Department of Internal Medicine and Pediatrics Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium Department of Anesthesiology Intensive Care and Emergency MedicineFondazione Policlinico Universitario A.Gemelli IRCCSRomeItaly UniversitàCattolica del Sacro Cuore RomeItaly Intensive Care Unit Papageorgiou University Affiliated HospitalThessaloníkiGreece Department of Epidemiology and Public Health SciensanoIxellesBelgium Surrey Perioperative Anaesthetic Critical Care Collaborative Research Group(SPACeR) Royal Surrey County HospitalGuildfordUK Department of Clinical and Experimental Medicine University of SurreyGuildfordUK Department of Intensive Care Medicine University Medical Center UtrechtUniversity UtrechtUtrechtthe Netherlands Department of Intensive Care Medicine Ghent University HospitalGhentBelgium Data Science Institute Ghent University HospitalGhentBelgium Department of Anesthesiology and Reanimation Cerrahpasa School of MedicineIstanbul University-CerrahpasaIstanbulTurkey rd Department of Critical Care “EVGENIDIO”HospitalNational and Kapodistrian University of AthensAthensGreece Department of General Visceral and Thoracic SurgeryKlinikum Hannoversch-MuendenGoettingen UniversityGöttingenGermany Division of Scientific Affairs-Research European Society of Intensive Care MedicineBrusselsBelgium Anesthesia and Intensive Care Department University Hospital of ModenaModenaItaly UQ Centre for Clinical Research Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia nd Critical Care Department Attikon University HospitalAthensGreece Department of Nursing Faculty of EducationHealth and Social WorkUniversity College GhentGhentBelgium Jamieson Trauma Institute The University of QueenslandBrisbaneQLDAustralia Nimes University Hospital University of MontpellierNimesFrance Critical Care Department Hospital of the Interamerican Open University(UAI)Buenos AiresArgentina Surgical Critical Care Department of AnesthesiaHospital Universitario

Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)presence or absence of either localized or diffuse peritonitis,and(3)severity of disease expression(infection,sepsis,or septic shock).This classification system demonstrated reliable risk stratification in intensive care unit(ICU)patients with intra-abdominal infection.This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality.Methods:This was a secondary analysis of an international observational study(“AbSeS”)investigating ICU patients with intra-abdominal infection.Only patients with pancreatic infection were included in this analysis(n=165).Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU.Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio(OR)and 95%confidence interval(CI).Results:The overall mortality was 35.2%(n=58).The independent risk factors for mortality included older age(OR=1.03,95%CI:1.0 to 1.1 P=0.023),localized peritonitis(OR=4.4,95%CI:1.4 to 13.9 P=0.011),and persistent signs of inflammation at day 7(OR=9.5,95%CI:3.8 to 23.9,Pinfection,a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome.In this limited series,essentials of the AbSeS-classification,such as the setting of infection onset,diffuse peritonitis,and severity of disease expression,

关键词： Pancreatic infection Intensive care unit Mortality intra-abdominal infection Sepsis

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Timing of surgical operation for patients with intra-abdominal infection:A systematic review and meta-analysis

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World Journal of Gastrointestinal Surgery 2023年第10期15卷 2320-2330页

作者： Shu-Rui Song Yang-Yang Liu Yu-Ting Guan Ruo-Jing Li Lei Song Jing Dong Pei-Ge Wang Department of Emergency Surgery The Affiliated Hospital of Qingdao UniversityQingdao 266000Shandong ProvinceChina Medical Complex Building Qingdao UniversityQingdao 266071Shandong ProvinceChina

BACKGROUND intra-abdominal infections(IAIs)is the most common type of surgical infection,with high associated morbidity and mortality rates.In recent years,due to the use of antibiotics,various drug-resistant bacteria have emerged,making the treatment of abdominal infections more challenging.Early surgical exploration can reduce the mortality of patients with abdominal infection and the occurrence of complications.However,available evidence regarding the optimal timing of IAI surgery is still weak.In study,we compared the effects of operation time on patients with abdominal cavity infection and tried to confirm the best timing of surgery.AIM To assess the efficacy of early vs delayed surgical exploration in the treatment of IAI,in terms of overall mortality.METHODS A systematic literature search was performed using PubMed,EMBASE,Cochrane Central Register of Controlled Trials,Ovid,and ScienceDirect.The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method.Based on the timing of the surgical operation,we divided the literature into two groups:Early surgery and delayed surgery.For the early and delayed surgery groups,the intervention was performed with and after 12 h of the initial surgical intervention,respectively.The main outcome measure was the mortality rate.The literature search was performed from May 5 to 20,2021.We also searched the World Health Organization International Clinical Trials Registry Platform search portal and ClinicalTrials.gov on May 20,2021,for ongoing trials.This study was registered with the International Prospective Register of Systematic Reviews.RESULTS We identified nine eligible trial comparisons.Early surgical exploration of patients with IAIs(performed within 12 h)has significantly reduced the mortality and complications of patients,improved the survival rate,and shortened the hospital stay.CONCLUSION Early surgical exploration within 12 h may be more effective for the treatment of IAIs relative to a delayed operation.

关键词： intra-abdominal infection Surgical exploration Timing infection Surgical operation Systematic review Metaanalysis

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Predictive value of immune cell counts and neutrophil-to-lymphocyte ratio for 28-day mortality in patients with sepsis caused by intra-abdominal infection

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Burns & Trauma 2021年第1期9卷 573-583页

作者： Shuangqing Liu Yuxuan Li Fei She Xiaodong Zhao Yongming Yao Medical school of Chinese PLA No.28 Fuxing RoadHaidian DistrictBeijing 100853China Department of Emergency the Fourth Medical Center of the Chinese PLA General HospitalNo.51 Fucheng RoadHaidian DistrictBeijing 100048China Trauma Research Center the Fourth Medical Center of the Chinese PLA General HospitalNo.51 Fucheng RoadHaidian DistrictBeijing 100048China

Background:The current study aimed to evaluate the value of immune cell counts and neutrophilto-lymphocyte ratio(NLR)when attempting to predict 28-day mortality.Methods:We conducted an observational retrospective study that included consecutive septic patients.Severity scores on the first day and peripheral circulating immune cell counts(at day 1,day 3,day 5 and day 7 of admission)were collected during each patient’s emergency intensive care unit stay.We assessed the associations of peripheral circulating immune cell counts and NLR with the severity of illness.The relationships between 28-day mortality and peripheral circulating immune cell counts and NLR with were evaluated using Cox proportional cause-specific hazards models.Results:A total of 216 patients diagnosed with sepsis caused by IAI were enrolled.The lymphocyte counts(days 1,3,5 and 7)and monocyte counts(days 3,5 and 7)were significantly lower in nonsurvivors(n=72)than survivors(n=144).The NLR values at each time point were significantly higher in non-survivors.The day 1 lymphocyte counts,as well as the monocyte counts,were significantly lower in the highest-scoring group,when stratified by the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores,than in the other groups(p<0.05).The day 1 NLR was significantly higher in the highest-scoring group than in the other groups(p<0.05).The day 5 and day 7 lymphocyte counts,day 3 and day 7 monocyte counts and day 7 NLR were significant predictors of 28-day mortality in the Cox proportional hazards models(day 5 lymphocyte count:hazard ratio,0.123(95%CI,0.055–0.279),p<0.001;day 7 lymphocyte count:hazard ratio,0.115(95%CI,0.052–0.254),p<0.001;day 3 monocyte count:hazard ratio,0.067(95%CI,0.005–0.861),p=0.038;day 7 monocyte count:hazard ratio,0.015(95%CI,0.001–0.158),p<0.001;day 7 NLR:hazard ratio,0.773(95%CI,0.659–0.905),p=0.001).Conclusions The results showed that circulating lymphocytes and monocytes were dramatically decreased within 7 days in non-survivors following

关键词： Lymphocyte counts Monocyte counts Predictive value Mortality Sepsis intra-abdominal infection

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Causative Microorganisms Isolated from Patients with intra-abdominal infections and Their Drug Resistance Profiles:An 11-Year(2011–2021)Single-Center Retrospective Study

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生物医学与环境科学:英文版 2023年第8期36卷 732-742页

作者： DING Rui MA Rui Rui LIU Ya Li ZHAO Ying GUO Li Na DOU Hong Tao SUN Hong Li LIU Wen Jing ZHANG Li WANG Yao LI Ding Ding YI Qiao Lian XU Ying Chun Department of Laboratory Medicine State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases Beijing 100730China Graduate School Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China

Objective To investigate the distribution and antimicrobial susceptibility of causative microorganisms recovered from patients with intra-abdominal infections(IAIs).Methods A total of 2,926 bacterial and fungal strains were identified in samples collected from 1,679 patients with IAIs at the Peking Union Medical College Hospital between 2011 and 2021.Pathogenic bacteria and fungi were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.Antimicrobial susceptibility testing(AST)was performed using the VITEK 2 compact system and the Kirby–Bauer method.AST results were interpreted based on the M100-Ed31 clinical breakpoints of the Clinical and Laboratory Standards Institute.Results Of the 2,926 strains identified,49.2%,40.8%,and 9.5%were gram-negative bacteria,gram-positive bacteria,and fungi,respectively.Escherichia coli was the most prevalent pathogen in intensive care unit(ICU)and non-ICU patients;however,a significant decrease was observed in the isolation of E.coli between 2011 and 2021.Specifically,significant decreases were observed between 2011 and 2021 in the levels of extended-spectrumβ-lactamase(ESBL)-producing E.coli(from 76.9%to 14.3%)and Klebsiella pneumoniae(from 45.8%to 4.8%).Polymicrobial infections,particularly those involving co-infection with gram-positive and gram-negative bacteria,were commonly observed in IAI patients.Moreover,Candida albicans was more commonly isolated from hospital-associated IAI samples,while Staphylococcus epidermidis had a higher ratio in community-associated IAIs.Additionally,AST results revealed that most antimicrobial agents performed better in non-ESBL-producers than in ESBL-producers,while the overall resistance rates(56.9%–76.8%)of Acinetobacter baumanmii were higher against all antimicrobial agents than those of other common gram-negative bacteria.Indeed,Enterococcus faecium,Enterococcus faecalis,S.epidermidis,and S.aureus were consistently found to be susceptible to vancomycin,teicoplanin,and linezolid.Similarly,C.albicans

关键词： intra-abdominal infection Causative microorganisms Antimicrobial susceptibility testing Gram-negative bacteria Gram-positive bacteria

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Clostridium perfringens gas gangrene caused by closed abdominal injury: A case report and review of the literature

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World Journal of Clinical Cases 2023年第4期11卷 852-858页

作者： He-Yun Li Zhi-Xiang Wang Jian-Chun Wang Xiao-Di Zhang Department of Intensive Care Unit Shaanxi Nuclear Industry 215 HospitalXianyang 712000Shaanxi ProvinceChina Department of General Surgery Shaanxi Nuclear Industry 215 HospitalXianyang 712000Shaanxi ProvinceChina Department of Healthcare-associate infection Management Shaanxi Nuclear Industry 215 HospitalXianyang 712000Shaanxi ProvinceChina

BACKGROUND abdominal Clostridium perfringens(C. perfringens) gas gangrene is a rare infection that has been described in the literature as most frequently occurring in postoperative patients with open trauma. intra-abdominal gas gangrene caused by C.perfringens infection after closed abdominal injury is extremely rare, difficult to diagnose, and progresses rapidly with high mortality risk. Here, we report a case of C. perfringens infection caused by closed abdominal injury.CASE SUMMARY A 54-year-old male suffered multiple intestinal tears and necrosis after sustaining an injury caused by falling from a high height. These injuries and the subsequent necrosis resulted in intra-abdominal C. perfringens infection. In the first operation,we removed the necrotic intestinal segment, kept the abdomen open and covered the intestine with a Bogota bag. A vacuum sealing drainage system was used to cover the outer layer of the Bogota bag, and the drainage was flushed under negative pressure. The patient was transferred to the intensive care unit for supportive care and empirical antibiotic treatment. The antibiotics were not changed until the results of bacterial culture and drug susceptibility testing were obtained.Two consecutive operations were then performed due to secondary intestinal necrosis. After three definitive operations, the patient successfully survived the perioperative period. Unfortunately, he died of complications related to GuillainBarre syndrome 75 d after the first surgery. This paper presents this case of intraabdominal gas gangrene infection and analyzes the diagnosis and treatment based on a review of current literature.CONCLUSION When the intestines rupture leading to contamination of the abdominal cavity by intestinal contents, C. perfringens bacteria normally present in the intestinal tract may proliferate in large numbers and lead to intra-abdominal infection. Prompt surgical intervention, adequate drainage,appropriate antibiotic therapy, and intensive supportive care comprise the most effective tr

关键词： Clostridium perfringens intra-abdominal infection Gas gangrene Open abdomen Case report

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The microbiology of infected pancreatic necrosis

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Hepatobiliary & Pancreatic Diseases International 2018年第5期17卷 456-460页

作者： Nicholas G.Mowbray Bassam Ben-Ismaeil Mohammed Hammoda Guy Shingler Bilal Al-Sarireh Swansea University Medical School Singleton Park Campus Abertawe Bro-Morgannwg University Health Board Public Health Wales Microbiology ABM Morriston Hospital Abertawe Bro-Morgannwg University Health Board Department of Surgery Morriston Hospital

Background: Acute pancreatitis(AP) continues to cause significant morbidity and mortality, especially when it leads to infected pancreatic necrosis(IPN). Modern treatment of IPN frequently involves prolonged courses of antibiotics in combination with minimally invasive therapies. This study aimed to update the existing evidence base by identifying the pathogens causing IPN and therefore aid future selection of empirical antibiotics. Methods: Clinical data, including microbiology results, of consecutive patients with IPN undergoing minimally invasive necrosectomy at our institution between January 2009 and July 2016 were retrospectively reviewed. Results: The results of 40 patients(22 males and 18 females, median age 60 years) with IPN were reviewed. The etiology of AP was gallstones, alcohol, dyslipidemia and unknown in 31, 2, 2 and 5 patients, respectively. The most frequently identified microbes in microbiology cultures were Enterococcus faecalis and faecium(22.5% and 20.0%) and Escherichia coli(20.0%). In 19 cases the cultures grew multiple organisms. The antibiotics with the least resistance amongst the microbiota were teicoplanin(5.0%), linezolid(5.6%), ertapenem(6.5%), and meropenem(7.4%). Conclusion: The carbapenem antibiotics, ertapenem and meropenem provide good antimicrobial cover against the common, mainly enteral, microorganisms causing IPN. Culture and sensitivity results of acquired samples should be regularly reviewed to adjust prescribing and monitor for emergence of resistance.

关键词： Acute pancreatitis Pancreatic abscess Pancreatic necrosis Infected pancreatic necrosis Antibiotics intra-abdominal infection

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Current progress of source control in the management of intra-abdominal infections

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Chinese Journal of Traumatology 2020年第6期23卷 311-313页

作者： Xiu-Wen Wu Tao Zheng Zhi-Wu Hong Hua-Jian Ren Lei Wu Ge-Fei Wang Guo-Sheng Gu Jian-An Ren Research Institute of General Surgery Jinling HospitalMedical School of Nanjing UniversityNanjingChina Lab for Trauma and Surgical infection Jinling HospitalNanjingChina

intra-abdominal infection(IAI)is a deadly condition in which the outcome is associated with urgent diagnosis,assessment and management,including fluid resuscitation,antibiotic administration while obtaining further laboratory results,attaining precise measurements of hemodynamic status,and pursuing source control.This last item makes abdominal sepsis a unique treatment challenge.Delayed or inadequate source control is an independent predictor of poor outcomes and recognizing source control failure is often difficult or impossible.Further complicating issue in the debate is surrounding the timing,adequacy,and procedures of source control.This review evaluated and summarized the current approach and challenges in IAI management,which are the future research directions.

关键词： Source control intra-abdominal infection Open abdomen Source control failure

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LPS－Induced Cellular Immunity ResponseandEffect of Herbal Purgation Method in intra－abdominal infections

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Chinese Journal of Integrative Medicine 1995年第3期1卷 166-170页

作者：秦明放吴咸中 Tianjin Institute of Acute abdominal Diseases by Integrated Traditional Chinese and Western Medicine Tianjin

The alterations of cytokines (TNF, PGE2) . plasma lipopolysaccharide and their prognosticinfluences in 58 patients with intra-abdominal infection were observed with enzyme linked immunosorbentassay (ELISA) and radioimmunoassay (RIA) . The result revealed earlier improvement of abnormal valuesof parameters, faster reduction of the level of and detectable rate of serum tumor necrosis tactor, higherendotoxin detoxication rate and lower morbidity in the treated group than in the control. The theoreticalbasis of pharmacological effect and possible mechanism were explored.

关键词： intra-abdominal infection lipopolysaccharide tumor necrosis factor herbal purgationmethod

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