title: Microbiology of Pelvic Lymphocyst Infection after Lymphadenectomy for Malignant Gynecologic Tumors.
abstract: 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.
authors: 1Division of Infectious Diseases, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan.
authors: Ichiro
authors: I
authors: Kawamura
authors: 2Division of Gynecology, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan.
authors: Yasuyuki
authors: Y
authors: Hirashima
authors: 1Division of Infectious Diseases, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan.
authors: Mika
authors: M
authors: Tsukahara
authors: 3Clinical Trial Coordination Office, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan.
authors: Keita
authors: K
authors: Mori
authors: 1Division of Infectious Diseases, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan.
authors: Hanako
authors: H
authors: Kurai
mesh_terms: D000328:Adult; D001421:Bacteria, Anaerobic / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006094:Gram-Positive Bacteria / Q000145:classification / Q000302:isolation & purification; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D062606:Tertiary Care Centers