title: Infection control for prevention of pancreatic fistula after pancreaticoduodenectomy.
abstract: OBJECTIVE
  Effectiveness of infection control for prevention of pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is not clear. We analyzed the impact of infection on the development of PF and examined the effect of enhanced infection control to prevent PF.
  
  
  METHODS
  Amylase level (D-amylase) and bacterial culture (D-culture) of drainage fluid were evaluated on POD 1, 3, 5 and 7, in 90 consecutive patients with soft pancreas who underwent PD. The study period was divided into two periods. The relationship between D-amylase and D-culture was examined, and the clinicopathological factors predicting PF were analyzed in the first period. Then, anti-infection measures were introduced in the second period, and the effect of enhanced infection control was examined.
  
  
  RESULTS
  Twenty-nine out of 58 patients (50.0%) developed PF in the first period. D-amylase were higher in patients with D-culture infection than in those without it (p<0.05). D-amylase above 10,000IU/L on POD1 and D-culture infection on POD3 were independent predictive factors for PF by multivariate analysis (p<0.01). After introduction of enhanced infection control in the second period, four out of 32 patients (12.5%) developed PF. The rates of PF and D-culture infection were significantly reduced (p<0.05).
  
  
  CONCLUSIONS
  Infection of drainage fluid is related to an increased level of amylase, resulting in PF. Enhanced infection control can effectively prevent PF after PD in soft pancreas.
authors.forename: Shin
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Naoto
authors.initials: N
authors.lastname: Gotohda
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kato
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
authors.forename: Taira
authors.initials: T
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000032:analysis; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D010185:Pancreatic Fistula / Q000382:microbiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy; D011237:Predictive Value of Tests; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000681:Amylases