Bacterial translocation after cirrhotic liver resection: a clinical investigation of 181 patients.
BACKGROUND
Cirrhotic patients are usually associated with a high susceptibility to infection. Although bacterial translocation from gut mucosa to mesenteric lymph node (MLN) and systemic circulation is a well-known phenomenon after hepatectomy, its role in cirrhotic patients remains unclear.


METHODS
MLN was harvested for bacterial culture before and after liver resection in 181 cirrhotic patients. The characteristics and postoperative courses of patients with positive and negative bacterial culture for MLN after hepatectomy were compared. Postoperative systemic antibiotics were administered if infectious complications occurred.


RESULTS
No bacteria were cultured in MLN before hepatectomy. Bacterial translocation (BT) to MLN after hepatectomy occurred in 36 patients (BT group). After multivariate analysis, intraoperative blood transfusion was the only independent factor that influenced bacterial translocation rates after cirrhotic liver resection. BT group patients also had higher infectious and overall complication rates, with a longer postoperative hospital stay. Among the cultured bacteriae from infected sites in BT group patients with infectious complications, only 2 patients (12.5%) had totally different bacterial species to those cultured from MLNs.


CONCLUSIONS
Bacterial translocation more often occurred after liver resection in cirrhotic patients who received intraoperative blood transfusion. Such patients had higher postoperative infectious and overall complication rates. Thus, avoidance of intraoperative blood transfusion is mandatory for cirrhotic liver resection.
Yeh
Dah-Cherng
DC
Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Wu
Cheng-Chung
CC
Ho
Wai-Meng
WM
Cheng
Shao-Bin
SB
Lu
I-Yin
IY
Liu
Tse-Jia
TJ
P'eng
Fang-Ku
FK
D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology; D018988:Bacterial Translocation / Q000502:physiology*; D001441:Bacteroides fragilis / Q000302:isolation & purification; D003352:Corynebacterium / Q000302:isolation & purification; D016972:Enterobacter cloacae / Q000302:isolation & purification; D013293:Enterococcus faecalis / Q000302:isolation & purification; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007413:Intestinal Mucosa / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000601:surgery*; D008198:Lymph Nodes / Q000382:microbiology; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D011183:Postoperative Complications; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D013211:Staphylococcus aureus / Q000302:isolation & purification; D034363:Viridans Streptococci / Q000302:isolation & purification