title: Pseudomonas aeruginosa Infection after Pancreatoduodenectomy: Risk Factors and Clinic Impacts.
abstract: BACKGROUND
  Pseudomonas aeruginosa (P. aeruginosa) is a leading cause of nosocomial infections, which is difficult to treat because of limited susceptibility to antimicrobial agents. In China, isolation rates of P. aeruginosa were observed to increase by year. The incidence of infectious complications after pancreatoduodenectomy (PD) were high. However, there was no data available regarding P. aeruginosa infection in patients undergoing PD. This study evaluated the risk factors and clinical impacts of P. aeruginosa infection on patient after PD.
  
  
  METHODS
  119 patients who underwent PD with post-operative infectious complications were monitored for P. aeruginosa infection. The patients were grouped as P. aeruginosa infection and non-P. aeruginosa infection. Univariable and multivariable analyses were used to identify risk factors for P. aeruginosa infection.
  
  
  RESULTS
  42 (35.3%) of the119 patients were P. aeruginosa positive after PD. The sites of P. aeruginosa infection included (1) abdominal drain fluid (76%); (2) sputum (7%); (3) central line catheter tip cultures (2%); and (4) combination of sites (14%). Pseudomonas aeruginosa isolates were susceptible to Polymyxin B, Amikacin and Gentamicin, resistant to Aztreonam Piperacillin-tazobactam, Imipenem and Ceftazidime. History of diabetes mellitus (OR=2.981, P=0.023), pancreatic fistula (OR=4.699, P=0.001), use of carbapenems (OR=3.236, P=0.013), and fluoroquinolones (OR=2.940, P=0.044), antibiotics, and length of ICU stay (OR=2.133, P=0.022) independently predicted post-operative P. aeruginosa infection. Pseudomonas aeruginosa infection was related to severe post-operative complications, including delayed gastric emptying and post-pancreatectomy hemorrhage, but was not related to not 30-d mortality or a longer post-operative stay.
  
  
  CONCLUSIONS
  This analytic study highlights the prevalence and high drug resistance of P. aeruginosa after PD. Pseudomonas aeruginosa infection was related to severe post-operative complications but not 30-d mortality. Measures to combat P. aeruginosa infection would likely decrease the accidence of P. aeruginosa infection and benefit patients' outcomes.
authors.affiliation: 1 Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China .
authors.forename: Jun-Feng
authors.initials: JF
authors.lastname: Zhang
authors.affiliation: 2 Department of General Surgery, The First People's Hospital of Suqian, Suqian City , Jiangsu Province, China .
authors.forename: Hong-Yan
authors.initials: HY
authors.lastname: Zhu
authors.affiliation: 1 Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China .
authors.forename: Yong-Wei
authors.initials: YW
authors.lastname: Sun
authors.affiliation: 1 Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China .
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: 1 Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China .
authors.forename: Yan-Miao
authors.initials: YM
authors.lastname: Huo
authors.affiliation: 1 Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China .
authors.forename: De-Jun
authors.initials: DJ
authors.lastname: Liu
authors.affiliation: 1 Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China .
authors.forename: Jiao
authors.initials: J
authors.lastname: Li
authors.affiliation: 1 Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China .
authors.forename: Rong
authors.initials: R
authors.lastname: Hua
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002681:China / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D015995:Prevalence; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents