scholarly journals The Occurrence of Klebsiella pneumoniae in Drainage Fluid After Pancreaticoduodenectomy: Risk Factors and Clinical Impacts

2021 ◽  
Vol 12 ◽  
Author(s):  
Yifei Yang ◽  
Xu Fu ◽  
Zhenghua Cai ◽  
Yudong Qiu ◽  
Liang Mao
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Preventive Measures ◽  
Multivariate Analyses ◽  
Preoperative Biliary Drainage ◽  
Postoperative Pancreatic Fistula ◽  
Perioperative Outcomes ◽  
Biliary Leakage ◽  
Drainage Fluid ◽  
Independent Risk Factors

To investigate the risk factors and clinical impacts of the occurrence of Klebsiella pneumoniae isolated from drainage fluid in patients undergoing pancreaticoduodenectomy (PD). Clinicopathological data of all patients who underwent PD from January 2018 to March 2021 were analyzed retrospectively. The univariate and multivariate analyses were performed to identify independent risk factors for the occurrence of K. pneumoniae in drainage fluid and its clinical impacts on postoperative complications. Of the included 284 patients, 49 (17.2%) patients isolated K. pneumoniae in drain samples after PD. Preoperative biliary drainage (OR = 1.962, p = 0.037) independently predicted the contamination of K. pneumoniae in drain samples after PD. The rate of clinically relevant postoperative pancreatic fistula (CR-POPF), major complications (Clavien–Dindo Grade ≥ III), post-pancreatectomy hemorrhage (PPH), organ/space surgical site infection (SSI), and biliary leakage (BL) were significantly higher in K. pneumoniae positive group both in the univariate and multivariate analyses. Preventive measures and treatments for combating K. pneumoniae contamination may be beneficial to the perioperative outcomes of patients after PD.

Clinical Impact of Preoperative Cholangitis after Biliary Drainage in Patients who Undergo Pancreaticoduodenectomy on Postoperative Pancreatic Fistula

2014 ◽  
Vol 80 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Hiroaki Yanagimoto ◽  
Sohei Satoi ◽  
Tomohisa Yamamoto ◽  
Hideyoshi Toyokawa ◽  
Satoshi Hirooka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Biliary Drainage ◽  
Multivariate Analyses ◽  
Preoperative Biliary Drainage ◽  
Postoperative Pancreatic Fistula ◽  
Prophylactic Antibiotics ◽  
Clinical Background ◽  
Study Population ◽  
Independent Risk Factors

The objective of this study was to examine whether the development of cholangitis after preoperative biliary drainage (PBD) can increase the incidence of postoperative pancreatic fistula (POPF). The study population included 185 consecutive patients who underwent pancreaticoduodenectomy from April 2006 to March 2011. All patients were divided into two groups, which consisted of a “no PBD” group (73 patients) and a PBD group (112 patients). Moreover, the PBD group was divided into a “cholangitis” group (21 patients) and a “no cholangitis” group (91 patients). Clinical background, clinical outcome, and postoperative complications were compared between groups. All patients received prophylactic antibiotics using cefmetazole until 1 or 2 days postoperatively. There was no difference between noncholangitis and non-PBD groups except the frequency of overall POPF. Clinically relevant POPF and drain infection occurred in the cholangitis group significantly more than in the noncholangitis group ( P < 0.05). Univariate and multivariate analyses showed that development of preoperative cholangitis after preoperative biliary drainage and small pancreatic duct (less than 3 mm diameter) were independent risk factors for clinically relevant POPF. The frequency of clinically relevant POPF was 8 per cent (eight of 99) in patients without two risk factors, 19 per cent (15 of 80) in patients with one risk factor, and 50 per cent (three of six) in patients with both risk factors. The development of preoperative cholangitis after PBD was closely associated with the development of clinically relevant POPF under the limited use of prophylactic antibiotics.

Double-Volume Intraoperative Lavage Reduce Bacterial Contamination After Pancreaticoduodenectomy

2020 ◽  
pp. 000313482095634
Author(s):  
Ryota Matsuki ◽  
Masanori Sugiyama ◽  
Hirokazu Momose ◽  
Masaharu Kogure ◽  
Yutaka Suzuki ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Peritoneal Lavage ◽  
Bacterial Culture ◽  
Lavage Fluid ◽  
Preoperative Biliary Drainage ◽  
Postoperative Pancreatic Fistula ◽  
Drainage Fluid ◽  
Bacterial Cultures ◽  
Positive Bacterial Culture ◽  
Independent Risk Factors

Background To clarify whether double-volume peritoneal lavage can decrease the risk of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy. Materials and Methods Forty-nine patients who underwent pancreaticoduodenectomy and intraoperative peritoneal lavage using 6000 mL of saline before abdominal closure were studied retrospectively. Bacterial cultures of the lavage fluid were taken twice, after irrigation using 3000 mL of saline and then after an additional 3000 mL of saline. Bacterial culture of the drainage fluid was taken on day 1, and the relationship between the results of bacterial cultures and clinically relevant postoperative pancreatic fistula was examined. Results Double amount of peritoneal lavage significantly decreased the incidence of positive bacterial cultures than single amount of peritoneal lavage (45% vs. 29%, P < .05). Multivariate analysis showed that positive bacterial culture of drainage fluid on day 1 and main pancreatic duct size (<3 mm) were independent risk factors for clinically relevant postoperative pancreatic fistula. A positive bacterial culture of the final lavage fluid and preoperative biliary drainage were independent factors related to a positive bacterial culture on day 1. Discussion A positive bacterial culture on day 1 is an independent risk factor for clinically relevant postoperative pancreatic fistula during pancreaticoduodenectomy. Double-volume intraperitoneal lavage may be effective for reducing the incidence of clinically relevant postoperative pancreatic fistula.

Disease Severity Is an Independent Risk Factor of Mortality and Outcomes in Critically Ill Patients With Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections: a 5-year Retrospective Analysis

2021 ◽  
Author(s):  
Yuzhen Qiu ◽  
Wen Xu ◽  
Yunqi Dai ◽  
Ruoming Tan ◽  
Jialin Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill Patients ◽  
Bloodstream Infections ◽  
Polymyxin B ◽  
Mortality Rates ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Independent Risk Factors

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

Incidence And Risk Factors For Postoperative Pneumonia Following Surgically Treated Hip Fracture In Geriatric Patients: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Yunxu Tian ◽  
Yanbin Zhu ◽  
Kexin Zhang ◽  
Miao Tian ◽  
Shuhui Qin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Geriatric Patients ◽  
Multivariate Analyses ◽  
Postoperative Pneumonia ◽  
Multivariate Logistic Regression Model ◽  
Preventive Strategy ◽  
Tertiary Referral Center ◽  
Independent Risk Factors ◽  
Clinical Conditions

Abstract Objective: Large sample investigations for risk factors for pneumonia in elderly patients after hip fracture surgeries are lacking. The purpose of this study is to determine the incidence and risk factors for postoperative pneumonia in geriatric patients following hip fracture operations.Methods: A retrospective study of incidence and risk factors in a tertiary referral center between 2016 and 2020 was conducted. Geriatric patients who developed postoperative pneumonia after surgeries of hip fracture during hospitalization stay were defined as cases and those without as controls. Multivariate logistic regression model was used to evaluate risk factors for postoperative pneumonia.Results: This study included 3147 patients, and 182 developed postoperative pneumonia, denoting the rate of 5.7%. In the multivariate analyses, age (OR, 1.04; 95% CI, 1.02–1.06), sex (males) (OR, 2.27; 95% CI, 1.64-3.13), respiratory disease (OR, 3.74; 95% CI, 2.32–6.04), heart disease (OR, 1.68; 95% CI, 1.14–2.47), cerebrovascular disease (OR, 1.58; 95% CI, 1.11–2.27), liver disease (OR, 2.61; 95% CI, 1.33–5.15), preoperative stay (OR, 1.08; 95% CI, 1.05–1.11) and general anesthesia (OR, 1.61; 95% CI, 1.15-2.27) were identified as independent risk factors for postoperative pneumonia.Conclusions: This study identified several risk factors for pneumonia in geriatric patients after hip fracture operations, providing a viable preventive strategy for optimizing clinical conditions for reductionof postoperative pneumonia.

scholarly journals Epidemiology, risk factors and outcomes of Candida albicans vs. non-albicans candidaemia in adult patients in Northeast China

2019 ◽  
Vol 147 ◽  
Author(s):  
Wei Zhang ◽  
Xingpeng Song ◽  
Hao Wu ◽  
Rui Zheng
Keyword(s):  
Risk Factors ◽  
Antifungal Agents ◽  
Multivariate Analyses ◽  
Urinary Catheter ◽  
Bloodstream Infections ◽  
Tertiary Hospital ◽  
Adult Patients ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
Isolated Species

Abstract This study aimed to evaluate the clinical characteristics, risk factors and outcomes of adult patients with candidaemia caused by C. albicans vs. non-albicans Candida spp. (NAC). All adult hospitalised cases of candidaemia (2012–2017) at a tertiary hospital in Shenyang were included in the retrospective study, and a total of 180 episodes were analysed. C. parapsilosis was the most frequently isolated species (38.3%), followed by C. albicans (35.6%), C. glabrata (13.9%), C. tropicalis (10%) and others (2.2%). As initial antifungal therapy, 75.0%, 3.9%, 5.6% and 2.2% of patients received fluconazole, caspofungin, micafungin and voriconazole, respectively. Multivariate analyses revealed that total parenteral nutrition was associated with an increased risk of NAC bloodstream infections (BSI) (OR 2.535, 95% CI (1.066–6.026)) vs. C. albicans BSI. Additionally, the presence of a urinary catheter was associated with an increased risk of C. albicans BSI (OR 2.295 (1.129–4.666)) vs. NAC BSI. Moreover, ICU stay (OR 4.013 (1.476–10.906)), renal failure (OR 3.24 (1.084–9.683)), thrombocytopaenia (OR 7.171 (2.152–23.892)) and C. albicans (OR 3.629 (1.352–9.743)) were independent risk factors for candidaemia-related 30-day mortality, while recent cancer surgery was associated with reduced mortality risk (OR 26.479 (2.550–274.918)). All these factors may provide useful information to select initial empirical antifungal agents.

scholarly journals Molecular Epidemiological Characteristics of Klebsiella pneumoniae Associated with Bacteremia among Patients with Pneumonia

2015 ◽  
Vol 53 (3) ◽  
pp. 879-886 ◽  
Author(s):  
Ryota Ito ◽  
Yuichiro Shindo ◽  
Daisuke Kobayashi ◽  
Masahiko Ando ◽  
Wanchun Jin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Virulence Factors ◽  
Neoplastic Disease ◽  
Content Type ◽  
Genetic Lineages ◽  
Medical Institutions ◽  
Independent Risk Factors ◽  
Epidemiological Characteristics ◽  
Serotype K2

Some important virulence factors have been elucidated inKlebsiella pneumoniaeinfections. We investigated the relationship between virulence factors and multilocus sequence types (STs) and assessed the risk factors for bacteremia in patients with pneumonia due toK. pneumoniae. From April 2004 through April 2012, a total of 120K. pneumoniaeisolates from patients with pneumonia (23 with bacteremia and 97 without bacteremia) were collected from 10 medical institutions in Japan. Additionally, 10 strains ofK. pneumoniaeserotype K2 that were isolated >30 years ago were included in this study. These isolates were characterized using multilocus sequence typing (MLST), and the characteristics of their virulence factors, such as hypermucoviscosity phenotype and RmpA and aerobactin production between patients with and without bacteremia, were examined. MLST analysis was performed on the 120 isolates from patients with pneumonia, and some sequence type groups were defined as genetic lineages (GLs). GL65 was more prevalent among patients with bacteremia (21.7%) than in those without bacteremia (7.2%). The majority of the strains with serotype K2 were classified into GL14 or GL65, andrmpAand the gene for aerobactin were present in all GL65-K2 strains but absent in all GL14-K2 strains. In a multivariate analysis, the independent risk factors for bacteremia included GL65 (adjusted odds ratio [AOR], 9.46; 95% confidence interval [CI], 1.81 to 49.31), as well as neoplastic disease (AOR, 9.94; 95% CI, 2.61 to 37.92), immunosuppression (AOR, 17.85; 95% CI, 1.49 to 214.17), and hypoalbuminemia (AOR, 4.76; 95% CI, 1.29 to 17.61). GL65 was more prevalent among patients with bacteremia and was associated with the virulence factors ofK. pneumoniae.

scholarly journals Epidemiology of paediatric gastrointestinal colonisation by extended spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae isolates in north-west Cambodia

2017 ◽  
Author(s):  
JJ van Aartsen ◽  
CE Moore ◽  
CM Parry ◽  
P Turner ◽  
N Phot ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
Resistance Genes ◽  
Genetic Relatedness ◽  
De Novo ◽  
Intestinal Parasites ◽  
E Coli ◽  
Extended Spectrum ◽  
Independent Risk Factors

ABSTRACTExtended-spectrum cephalosporin resistance (ESC-R) in Escherichia coli and Klebsiella pneumoniae is a healthcare threat; high gastrointestinal carriage rates are reported from South-east Asia. Colonisation prevalence data in Cambodia are lacking. We determined gastrointestinal colonisation prevalence of ESC-resistant E. coli (ESC-R-EC) and K. pneumoniae (ESC-R-KP) in Cambodian children/adolescents and associated risk factors; characterised relevant resistance genes, their genetic contexts, and the genetic relatedness of ESC-R strains using whole genome sequencing (WGS). Faeces and questionnaire data were obtained from individuals <16 years in northwestern Cambodia, 2012. WGS of cultured ESC-R-EC/KP was performed (Illumina). Maximum likelihood phylogenies were used to characterise relatedness of isolates; ESC-R-associated resistance genes and their genetic contexts were identified from de novo assemblies using BLASTn and automated/manual annotation. 82/148 (55%) of children/adolescents were ESC-R-EC/KP colonised; 12/148 (8%) were co-colonised with both species. Independent risk factors for colonisation were hospitalisation (OR: 3.12, 95%, CI [1.52-6.38]) and intestinal parasites (OR: 3.11 [1.29-7.51]); school attendance conferred decreased risk (OR: 0.44 [0.21-0.92]. ESC-R strains were diverse; the commonest ESC-R mechanisms were blaCTX-M 1 and 9 sub-family variants. Structures flanking these genes were highly variable, and for blaCTX-M-15,-55and-27, frequently involved IS26. Chromosomal blaCTX-M integration was common in E. coli. Gastrointestinal ESC-R-EC/KP colonisation is widespread in Cambodian children/adolescents; hospital admission and intestinal parasites are independent risk factors. The genetic contexts of blaCTX-M are highly mosaic, consistent with rapid horizontal exchange. Chromosomal integration of blaCTX-M may result in stable propagation in these community-associated pathogens.

A Retrospective Analysis of Risk Factors and Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Bacteremia in Nontransplant Patients

2020 ◽  
Vol 221 (Supplement_2) ◽  
pp. S174-S183
Author(s):  
Tingting Xiao ◽  
Yunying Zhu ◽  
Shuntian Zhang ◽  
Yuan Wang ◽  
Ping Shen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Multivariate Logistic Regression Analysis ◽  
Severe Illness ◽  
Poor Clinical Outcome ◽  
Carbapenem Resistant ◽  
Definitive Therapy ◽  
New Ideas ◽  
Independent Risk Factors ◽  
Microbiological Data

Abstract Background Carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a major problem among nosocomial infections, and it is a serious threat to patients. The clinical characteristics and outcome of CRKP bloodstream infection (BSI) in nontransplant patients remains unelucidated. The aim of this study was as follows: identify the risk factors of CRKP infection; generate new ideas for prevention; and generate new ideas for the most effective therapeutic management in nontransplant patients. Methods The study retrospectively analyzed the clinical and microbiological data of nontransplant patients with K pneumoniae (KP) bacteremia from January 2013 to December 2015 to identify risk factors, clinical features, and outcomes using multivariate logistic regression analysis. Results Of the 371 patients with KP-BSI in nontransplant patients included in this study, 28.0% (N = 104) had CRKP. The 28-day mortality was higher in patients infected with CRKP (55.8%) than in those with carbapenem-susceptible KP (13.9%) (P &lt; .001). Multivariate analysis showed previous gastric catheterization, previous use of carbapenems, hypoproteinemia, and high Acute Physiologic Assessment and Chronic Health Evaluation II scores as independent risk factors for CRKP-BSIs. Carbapenem-resistant KP infection, severe illness, and tigecycline therapy were independent risk factors for death from KP-BSIs. Taken together, inappropriate antibiotic treatment both in empirical and definitive therapy and imipenem minimum inhibitory concentrations (MICs) of &gt;8 mg/L were associated with poor clinical outcome. Conclusions Nontransplant patients with CRKP-BSI had higher mortality. Carbapenems exposure was an independent risk factor for CRKP infection. Imipenem MICs of &gt;8 mg/L, tigecycline therapy, and inappropriate treatments increased the 28-day mortality of KP-BSI patients.

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