Poor outcomes after hepatectomy in patients with ascites infected by methicillin-resistant staphylococci
Poor outcomes after hepatectomy in patients with ascites infected by methicillin-resistant staphylococci
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耐甲氧西林葡萄球菌感染腹水患者肝切除术后预后不良
DOI：
10.1002/jhbp.175
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Baba H
中科院分区：
文献类型：
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作者：
Nitta H;Beppu T;Itoyama A;Higashi T;Sakamoto K;Nakagawa S;Mima K;Okabe H;Imai K;Hayashi H;Hashimoto D;Chikamoto A;Ishiko T;Baba H
背景本研究旨在探讨肝切除术后感染性腹水、临床参数和治疗结果之间的关系。方法在2006年至2013年期间接受肝切除术的891例患者中，分析了74例肝切除术后接受腹腔穿刺术进行术后腹水细菌培养的患者。结果在74例患者中，42例患者细菌培养阳性（阳性组），32例患者细菌培养阴性（阴性组）。阳性组的住院死亡率显著高于阴性组[9/42（21.4%）vs. 2/32（6.3%）;P= 0.035]。与每种细菌菌株相关的住院死亡率如下：耐甲氧西林葡萄球菌（MRS）（5/13，38.5%）、葡萄球菌（2/11，18.2%）、肠球菌（2/12，16.7%）、肠杆菌（0/3，0%）、克雷伯菌（0/2，0%）和其他（0/1，0%）。考克斯比例多因素分析显示腹水MRS感染是医院死亡的唯一危险因素（HR = 5.08，P = 0.041），MRS伤口感染是预测腹水MRS感染的唯一危险因素HR = 5.67，P = 0.015。结论肝切除术后腹水MRS感染是一种潜在的致命并发症;因此，预防MRS伤口感染对降低术后住院死亡率至关重要。
BackgroundThis study was designed to investigate the association between infectious ascites, clinical parameters and treatment outcomes after hepatectomy.MethodsOf 891 patients who underwent hepatectomy between 2006 and 2013, 74 who underwent paracentesis for bacterial cultivation of postoperative ascites after hepatectomy were analyzed.ResultsOf the 74 patients, 42 had positive bacterial cultures (positive group) and 32 patients had negative cultures (negative group). Hospital mortality was significantly higher in the positive group than in the negative group [9/42 (21.4%) vs. 2/32 (6.3%);P= 0.035]. Hospital mortality associated with each bacterial strain was as follows: methicillin‐resistant staphylococci (MRS) (5/13, 38.5%), staphylococci (2/11, 18.2%), enterococci (2/12, 16.7%),Enterobacter(0/3, 0%),Klebsiella(0/2, 0%), and others (0/1, 0%). Cox proportional multivariate analysis revealed that MRS infection in ascites was the only risk factor of hospital death (HR = 5.08,P= 0.041) and MRS wound infection was the only risk factor to predict MRS infection in ascites (HR = 5.67,P= 0.015).ConclusionPostoperative MRS infection in postoperative ascites after hepatectomy is a potentially fatal complication; therefore, the prevention of MRS wound infection is critical to decrease postoperative hospital mortality.