Analysis of risk factors of intra-abdominal infection after surgery for colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors of intra-abdominal infection(IAI) after colorectal cancer surgery.</p><p><b>METHODS</b>Clinical and follow-up data of 773 colorectal cancer patients undergoing operation in our hospital from October 2011 to December 2014 were retrospectively analyzed. Patients were divided into intra-abdominal cavity infection group (110 cases, IAI group) and non intra-abdominal infection group(663 cases, non-IAI group). All the patients administered prophylactic antibiotics 30 minutes to 2 hours before operation. Univariate and multivariate analysis were performed to evaluate the risk factors of IAI.</p><p><b>RESULTS</b>Preoperative factors associated with postoperative IAI included hepatic cirrhosis, kidney diseases, diabetes or other basic diseases, prophylactic use of drugs, hypoalbuminemia, anemia, intestinal obstruction, and American Society of Anesthesiologists (ASA) anesthetic grading score (all P<0.05). Postoperative factors associated with postoperative IAI included use of laparoscopy or stapler, united exenteration, existence of anastomotic fistula, time of drainage tube placement, operation time and tumor staging (all P<0.05). Multivariate logistic regression analysis showed that preoperative diabetes(OR=2.36, 95% CI:1.45 to 4.76, P<0.01), combined exenteration (OR=2.02, 95% CI:1.02 to 4.00, P<0.01), anastomotic leak (OR=4.41, 95% CI:1.77 to 10.99, P=0.001), operation time≥140 minutes (OR=2.88, 95% CI:1.78 to 4.67, P<0.01) and period of postoperative drainage≥10 days(OR=4.57, 95% CI:2.78 to 7.52, P<0.01) were independent risk factors of postoperative IAI, while the use of stapler was protective factor (OR=0.37, 95% CI: 0.23 to 0.60, P<0.01). Compared with prophylactic use of cephamycins plus metronidazole, cefuroxime plus metronidazole had a higher rate of IAI(OR=2.10, 95% CI:1.23 to 3.58, P=0.007).</p><p><b>CONCLUSIONS</b>Prevention of postoperative IAI is required for colorectal cancer patients, particularly in those with preoperative diabetes, combined exenteration, anastomotic leak, operation time longer than 140 minutes and postoperative drainage period longer than 10 days. Preoperative use of cephamycins plus metronidazole has better efficacy in prevention of postoperative IAI.</p>

Risk factors of surgical site infection in patients with colorectal cancer / 中华临床感染病杂志

Objective To investigate the incidence and risk factors of surgical site infection ( SSI ) in patients with colorectal cancer .Methods Clinical data of patients with colorectal cancer undergoing surgical treatment in Jiaxing First Municipal People’ s Hospital from October 2011 to December 2014 were retrospectively reviewed.The gender, age, underlying diseases, smoking history, preventive medication, abdominal surgery history , type of surgery , preoperative levels of hemoglobin and albumin , use of laparoscopy, use of stapler, combined organ resection, TNM staging, American Society of Anesthesiologists ( ASA) score was documented .Multivariate logistic regression analysis was performed to identify the risk factors of SSI .Results A total of 773 patients were enrolled in the study , and SSI was observed in 144 cases (18.63%).Multivariate logistic regression analysis showed that use of laparoscopy ( OR =0.35, 95%CI:0.15-0.79,P <0.05), use of stapler (OR =0.59, 95% CI: 0.39-0.88,P <0.05) were protective factors for SSI, while diabetes (OR=2.11, 95% CI: 1.25-3.58,P<0.01), liver cirrhosis (OR=2.12,95%CI:1.18-3.79,P<0.05), ASA score (3-4 points) (OR=2.01,95%CI:1.20-3.58, P<0.01), combined organ resection (OR=2.17,95% CI:1.20-3.92,P<0.05), and anastomotic leak (OR=6.85, 95%CI:3.01-15.63,P<0.01) were risk factors for SSI.Conclusions The incidence of SSI is high in patients with colorectal cancer undergoing surgery .Use of laparoscopy and stapler may reduce the incidence of SSI .

Analysis of Candida infections and drug sensitivity in intensive care unit / 中国中西医结合急救杂志

Objective To study the distribution of Candida infection and drug tolerance in intensive care unit(ICU). Methods A retrospective study was conducted. The critical patients admitted from January 2011 to December 2013 in ICU of the First Hospital of Jiaxing in Zhejiang Province were enrolled,and their clinical data with positive Candida culture and drug susceptibility results in specimens of sputum,urine,blood,ascites,bile, etc were collected. In the study of these 3 years in ICU,the situation of Candida infection,the distribution of positive specimen,the condition of distribution of different strains of Candida,and the Candida tolerance to antifungal drugs were analyzed. Results From 2011 to 2013,2 412 times of patients(including one patient had admitted into ICU for more than one time)were admitted into ICU in which 407 cases were of Candida infection(16.9%),and the rate of Candida infection was rising gradually in the 3 years〔2011 to 2013 Candida positive rates were 13.4%(77/573), 16.1%(146/907),19.7%(184/932)〕,the difference being statistically significant(P<0.01). In the 407 strains of Candida,166 strains(40.8%)were isolated from sputum,157(38.6%)from urine,53 strains(13.0%)ascites, 13 strains(3.1%)blood,11 strains(2.7%)bile,7 strains(1.7%)from other specimens. The strain distribution of Candida was mainly as follows:Candida albicans(174 strains),Candida glabrata(131 strains),Candida tropicalis (83 strains),Candida parapailosis(5 strains),Candida krusei(12 strains),and 2 strains of rare Candida portugal and Lipolztica. From 2011 to 2013,the highest tolerance of Candida albicans,Candida glabrata,Candida tropicalis to fluconazole,itraconazole,Fushita Yasu and other antifungal drugs was in 2013,and the lowest was in 2012,the rates of tolerance of the above 3 strains of Candida to amphotericin B being 0,to itraconazole being the highest(10.9%, 27.8%,9.6%,respectively),to Fushita Yasu the secondary(6.6%,11.0%,0,respectively)and to fluconazole the last(4.7%,7.4%,1.9%,respectively),and the rates of tolerance of Candida parapsilosis,Candida krusei,Candida Portugal,Candida lipolztica to amphotericin B,fluconazole,itraconazole,Fushita Yasu were all 0. Conclusion In ICU,the Candida infection is mainly in the respiratory tract and urinary tract,its rate of infection has a tendency of rising,and the rate of Candida tolerance to itraconazole is the highest.