title: Nosocomial Infections and Microbiologic Spectrum after Major Elective Surgery of the Pancreas, Liver, Stomach, and Esophagus.
abstract: BACKGROUND
  The majority of infections treated by surgeons are nosocomial infections (NI). The frequency of these infections in relation to the organ operated on as well as the organisms involved are not well defined. Detailed knowledge of these issues is essential for optimal care of surgical patients. This study aimed to determine infection rates and the responsible pathogens after major elective surgery of the pancreas, liver, stomach, and esophagus.
  
  
  METHODS
  Between January 1, 2005 and August 31, 2007, the records of all patients of the Department of General, Abdominal and Vascular Surgery, University Hospital Magdeburg (Germany) with elective resection of the pancreas, liver, stomach, and esophagus were evaluated retrospectively. Study parameters were: Patient number, age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, indication for resection, operation duration, length of stay (LOS) in the intensive care unit (ICU) and in hospital, mortality, organ-related rate and kind of NI, and microbiologic spectrum. Nosocomial infections were defined as: Surgical site infection (U.S. Centers for Disease Control and Prevention [CDC] 1 or 2) and intra-abdominal infection (CDC 3), urinary tract infection, clinical sepsis, blood stream and catheter-related infection, respiratory tract infection, and pneumonia.
  
  
  RESULTS
  A total of 358 patients were included: 150 (42%) with pancreas resection, 91 (25%) with liver resection, 105 (29%) with gastric resection, and 12 (3%) with esophagus resection. Median LOS in the ICU for all groups was 48.8 h (interquartile range [IQR] 24.9-91.8 h), median LOS in hospital was 16 d (IQR 13-23 d), and in-hospital mortality was 4.5%. Patients with NI had significantly greater in-hospital death and prolonged stay in hospital and ICU (p<0.001). In 120 (33.5%) patients, one or more NI occurred (range, 83% in esophagus patients to 21% in liver patients). Intra-abdominal (16.5%) and surgical site infections (12.3%) were most frequent; 80.8% of the NI were culture-positive. The most frequent clinically relevant isolates were Escherichia coli (12.4%), coagulase-negative staphylococci (CoNS) (12.2%), and Enterococcus faecium (9.7%). The highest resistance rates were found for Staphylococcus aureus (methicillin-resistant S. aureus [MRSA] 29.4%) and Pseudomonas aeruginosa (23.5%).
  
  
  CONCLUSIONS
  For patients undergoing elective surgery of the pancreas, liver, stomach, and esophagus, considerable differences in demographic factors, frequency, and kind of NI exist. The consequences of NI force surgeons to analyze pre-operative risk factors carefully, assess indications for operation thoroughly, and optimize all controllable parameters.
authors.affiliation: 1Department of General, Abdominal, and Vascular Surgery, University Hospital, Magdeburg, Germany.
authors.forename: Olof
authors.initials: O
authors.lastname: Jannasch
authors.affiliation: 1Department of General, Abdominal, and Vascular Surgery, University Hospital, Magdeburg, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Kelch
authors.affiliation: 2Department of Biometry and Medical Informatics, Otto von Guericke University Magdeburg, Magdeburg, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Adolf
authors.affiliation: 3Institute of Medical Microbiology, University Hospital, Magdeburg, Germany.
authors.forename: Ina
authors.initials: I
authors.lastname: Tammer
authors.affiliation: 1Department of General, Abdominal, and Vascular Surgery, University Hospital, Magdeburg, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Lodes
authors.affiliation: 4Department of Anaesthesiology and Intensive Care Medicine, Hospital Magdeburg, Magdeburg, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Weiss
authors.affiliation: 1Department of General, Abdominal, and Vascular Surgery, University Hospital, Magdeburg, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Lippert
authors.affiliation: 1Department of General, Abdominal, and Vascular Surgery, University Hospital, Magdeburg, Germany.
authors.forename: Pawel
authors.initials: P
authors.lastname: Mroczkowski
mesh_terms: D000368:Aged; D001419:Bacteria / Q000145:classification* / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004066:Digestive System Diseases / Q000601:surgery*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D016019:Survival Analysis