Po-Sheng Yang1,2, Chang-Pan Liu3, Yi-Chiung Hsu4, Chuen-Fei Chen5, Chi-Chan Lee6, Shih-Ping Cheng5,6. 1. Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan. psyang@mmc.edu.tw. 2. Department of General Surgery, MacKay Memorial Hospital, Taipei, Taiwan. psyang@mmc.edu.tw. 3. Department of Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan. 4. Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan. 5. Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan. 6. Department of General Surgery, MacKay Memorial Hospital, Taipei, Taiwan.
Abstract
BACKGROUND: Bloodstream infections (BSI) are an important source of postoperative mortality in hepatobiliary-pancreatic surgery (HBPS) patients, and no prediction model has been analyzed before. METHODS: Using big data from the electronic medical records of the administrative and culture databases of MacKay Memorial Hospital, we identified the potential risk factors for community-acquired and healthcare-associated BSI and mortality of patients who received HBPS. Subsequently, we analyzed the microorganisms' profiles and antimicrobial susceptibility patterns for these BSI. RESULTS: BSI were found in 6.3% patients (349 of 5513 HBPS patients), and hospital mortality was 1.48% (82 of 5513). Dividing patients into low-, intermediate-, and high-risk groups on the basis of sex, age, status of comorbidity (renal failure, peptic ulcer disease, fluid and electrolyte disorders, and acute cholecystitis), a predictive BSI risk score model was developed. According to this model, BSI risk ranged from 1.43% to 11.95%; AUROC to predict BSI risk was 0.72 (95% CI 0.69-0.75). From this retrospective study, Enterobacteriaceae were the most common microorganisms that were isolated from BSI. For both community-acquired and healthcare-associated BSI, imipenem and colistin are the most successful. CONCLUSION: This novel model can be useful to predict who is at risk of BSI after HBPS, and new prophylactic protocols for these patients are needed.
BACKGROUND: Bloodstream infections (BSI) are an important source of postoperative mortality in hepatobiliary-pancreatic surgery (HBPS) patients, and no prediction model has been analyzed before. METHODS: Using big data from the electronic medical records of the administrative and culture databases of MacKay Memorial Hospital, we identified the potential risk factors for community-acquired and healthcare-associated BSI and mortality of patients who received HBPS. Subsequently, we analyzed the microorganisms' profiles and antimicrobial susceptibility patterns for these BSI. RESULTS: BSI were found in 6.3% patients (349 of 5513 HBPS patients), and hospital mortality was 1.48% (82 of 5513). Dividing patients into low-, intermediate-, and high-risk groups on the basis of sex, age, status of comorbidity (renal failure, peptic ulcer disease, fluid and electrolyte disorders, and acute cholecystitis), a predictive BSI risk score model was developed. According to this model, BSI risk ranged from 1.43% to 11.95%; AUROC to predict BSI risk was 0.72 (95% CI 0.69-0.75). From this retrospective study, Enterobacteriaceae were the most common microorganisms that were isolated from BSI. For both community-acquired and healthcare-associated BSI, imipenem and colistin are the most successful. CONCLUSION: This novel model can be useful to predict who is at risk of BSI after HBPS, and new prophylactic protocols for these patients are needed.
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