title: Does Intraoperative Systematic Bacterial Sampling During Complete Cytoreductive Surgery (CRS) with Hyperthermic Intraoperative Peritoneal Chemotherapy (HIPEC) Influence Postoperative Treatment? A New Predictive Factor for Postoperative Abdominal Infectious Complications.
abstract: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an emerging curative treatment option for patients with peritoneal carcinomatosis. It has a long-term survival benefit but is associated with high rates of morbidity, ranging from 12 % to 65 %, mainly due to infectious complications. We sought to evaluate the clinical relevance of routine intraoperative bacteriological sampling following CRS/HIPEC.
  
  
  
  Between November 2010 and December 2014, every patients receiving CRS/HIPEC were included. Three samples were routinely collected from standardized locations for intraperitoneal rinsing liquid bacteriological analysis (RLBA) after completion of HIPEC. The clinical and surgical features, bacteriological results, and short-term outcomes were retrospectively reviewed.
  
  
  
  The overall mortality and morbidity rates were 5 and 45 %, respectively. Among the 75 included patients, 40 % (n = 30) had at least one positive bacterial culture. Risk factors for a positive culture were colorectal resection (adjusted hazard ratio [HR] = 3.072, 95 % CI 1.843-8.004; p = 0.009) and blood loss >1000 mL (HR = 4.272, 95 % CI 1.080-18.141; p = 0.031). Among 26 (35 %) patients with abdominal infectious complications, 13 (17 %) experienced isolated complications. A positive RLBA result was independently associated with abdominal infectious complications (HR = 5.108, 95 % CI 1.220-16.336; p = 0.024) and isolated abdominal infectious complications (HR = 4.199, 95 % CI 1.064-15.961; p = 0.04).
  
  
  
  Forty percent of the RLBA samples obtained following CRS/HIPEC tested positive for bacteria. Bacterial sampling of rinsing liquid should be systematically performed. An aggressive and immediate antibiotic strategy needs to be evaluated.
authors.affiliation: Department of Digestive Surgery, Hôpital Charles Nicolle, 1 rue de Germont, 76000, Rouen, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Dazza
authors.affiliation: Department of Digestive Surgery, Hôpital Charles Nicolle, 1 rue de Germont, 76000, Rouen, France.
authors.forename: Lilian
authors.initials: L
authors.lastname: Schwarz
authors.affiliation: Department of Digestive Surgery, Hôpital Charles Nicolle, 1 rue de Germont, 76000, Rouen, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Coget
authors.affiliation: Department of Bacteriology, Hôpital Charles Nicolle, Rouen, France.
authors.forename: Noelle
authors.initials: N
authors.lastname: Frebourg
authors.affiliation: Department of Anesthesiology, Hôpital Charles Nicolle, Rouen, France.
authors.forename: Gregory
authors.initials: G
authors.lastname: Wood
authors.affiliation: Department of Digestive Surgery, Hôpital Charles Nicolle, 1 rue de Germont, 76000, Rouen, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Huet
authors.affiliation: Department of Digestive Surgery, Hôpital Charles Nicolle, 1 rue de Germont, 76000, Rouen, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Bridoux
authors.affiliation: Surgical Intensive Care Unit, Hôpital Charles Nicolle, Rouen, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Veber
authors.affiliation: Department of Digestive Surgery, Hôpital Charles Nicolle, 1 rue de Germont, 76000, Rouen, France. jean-jacques.tuech@chu-rouen.fr.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016063:Blood Loss, Surgical; D001810:Blood Volume; D002277:Carcinoma / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D059413:Intraabdominal Infections / Q000209:etiology*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000382:microbiology*; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate