Microbiology of Pelvic Lymphocyst Infection after Lymphadenectomy for Malignant Gynecologic Tumors
Microbiology of Pelvic Lymphocyst Infection after Lymphadenectomy for Malignant Gynecologic Tumors
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DOI：
10.1089/sur.2014.021
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发表时间：
2015-06-01
影响因子：
2
通讯作者：
Kurai, Hanako
中科院分区：
文献类型：
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作者：
Kawamura, Ichiro;Hirashima, Yasuyuki;Kurai, Hanako
背景：盆腔淋巴囊肿感染是妇科恶性肿瘤淋巴结切除术后罕见的并发症。虽然药物治疗是外科引流的有效补充，但适当的抗生素治疗方案尚不清楚，因为很少有研究检查了致病微生物。本病例系列的目的是确定感染盆腔淋巴囊肿的微生物。方法：这是一项于2002年10月至2013年3月在一家三级保健癌症中心进行的单中心、回顾性、病例系列综述。参与者包括所有因宫颈癌、子宫内膜癌或卵巢癌行盆腔淋巴结切除术后首次盆腔淋巴囊肿感染且淋巴囊肿液培养阳性的患者。采用计算机断层扫描或超声引导下的经皮穿刺方法获得淋巴囊肿液进行培养。结果：在研究期间，878例妇科恶性肿瘤患者行淋巴结切除术，13例发生盆腔淋巴囊肿感染。培养鉴定出金黄色葡萄球菌（3例）、表皮葡萄球菌（1例）、无乳链球菌（3例）、肠球菌（2例）、大肠杆菌（1例）和厌氧菌（3例）。都是单菌感染。结论：我们的研究和其他一些较小的研究表明，妇科恶性肿瘤盆腔淋巴结切除术后的淋巴囊肿感染通常是单菌性的，由革兰氏阳性球菌（包括葡萄球菌、链球菌和肠球菌）和厌氧菌（如脆弱拟杆菌）引起。在选择经验性抗生素治疗时应考虑这些细菌。
Background: Pelvic lymphocyst infection is a rare complication after lymphadenectomy for malignant gynecologic tumors. Although medical therapy is a useful addition to surgical drainage, the appropriate antibiotic regimen is unknown because few studies have examined the causative organisms. The purpose of this case series was to identify the micro-organisms infecting pelvic lymphocysts. Methods: This was a single-center, retrospective, case-series review conducted at a tertiary-care cancer center between October 2002 and March 2013. The participants included all patients who experienced their first pelvic lymphocyst infection after undergoing pelvic lymphadenectomy for cervical, endometrial, or ovarian cancer and exhibited positive lymphocyst fluid culture. Computed tomography- or sonography-guided percutaneous aspiration procedures were performed to obtain lymphocyst fluid for culture. Results: During the study period, 878 patients underwent lymphadenectomy for gynecologic malignant tumors, and 13 developed a pelvic lymphocyst infection documented microbiologically. Cultures identified Staphylococcus aureus (three patients), S. epidermidis (one patient), Streptococcus agalactiae (three patients), Enterococcus (two patients), Escherichia coli (one patient), and anaerobic bacteria (three patients). They were all monomicrobial infections. Conclusions: Our study and other smaller ones suggest that lymphocyst infections following pelvic lymphadenectomy for malignant gynecologic tumors usually are monomicrobial and caused by gram-positive cocci, including Staphylococcus, Streptococcus, and Enterococcus, and anaerobes such as Bacteroides fragilis. These bacteria should be considered when selecting empiric antibiotic therapy.