title: Poor outcomes after hepatectomy in patients with ascites infected by methicillin-resistant staphylococci.
abstract: BACKGROUND
  This study was designed to investigate the association between infectious ascites, clinical parameters and treatment outcomes after hepatectomy.
  
  
  METHODS
  Of 891 patients who underwent hepatectomy between 2006 and 2013, 74 who underwent paracentesis for bacterial cultivation of postoperative ascites after hepatectomy were analyzed.
  
  
  RESULTS
  Of 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).
  
  
  CONCLUSIONS
  Postoperative 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.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Nitta
authors.forename: Toru
authors.initials: T
authors.lastname: Beppu
authors.forename: Akari
authors.initials: A
authors.lastname: Itoyama
authors.forename: Takaaki
authors.initials: T
authors.lastname: Higashi
authors.forename: Keita
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Kosuke
authors.initials: K
authors.lastname: Mima
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Okabe
authors.forename: Katsunori
authors.initials: K
authors.lastname: Imai
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Hayashi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hashimoto
authors.forename: Akira
authors.initials: A
authors.lastname: Chikamoto
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Ishiko
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D013530:Surgical Wound Infection / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D015996:Survival Rate / Q000639:trends
keywords: Ascites; Hepatectomy; Methicillin-resistant staphylococci