Masaya Suenaga1, Yukihiro Yokoyama2, Tsutomu Fujii3, Suguru Yamada1, Junpei Yamaguchi4, Masamichi Hayashi1, Takashi Asahara5, Masato Nagino4, Yasuhiro Kodera1. 1. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan. 2. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: yyoko@med.nagoya-u.ac.jp. 3. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan. 4. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 5. Yakult Central Institute, Tokyo, Japan.
Abstract
BACKGROUND: Occult-bacterial translocation (O-BT) has been reported as the condition in which microorganisms are detected in blood or lymph node by a highly sensitive method. However, the clinical impact of preoperative O-BT on postoperative complications is unclear. STUDY DESIGN: A prospective observational study with patients undergoing pancreatoduodenectomy for periampullary diseases was conducted. Blood samples were collected immediately after the induction of anesthesia. The status of O-BT was investigated using bacterium-specific ribosomal RNA-targeted reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR). The impact of O-BT on surgical site infections (SSIs) was analysed. RESULTS: A total of 155 patients were included. The positive rate in preoperative blood samples detected by RT-qPCR was significantly higher than that obtained by the culture method (32 of 155 vs 4 of 155, p<0.001). Preoperative blood samples were contaminated with 1.0 to 19.2 bacterial cells/mL in positive patients, and 30 of the 41 detected microorganisms were obligate anaerobes. No differences in preoperative factors were observed between patients with positive and negative RT-qPCR results. The incidence of any SSI was significantly higher in patients with contaminated preoperative blood (≥1.2 bacterial cells/mL) than in other patients (14 of 27 vs 35 of 128, p=0.013). Multivariable analysis indicated that contaminated preoperative blood was identified as one of the independent risk factors for SSIs (odds ratio 2.71, 95% CI 1.04 to 7.24, p=0.041). CONCLUSIONS: O-BT, predominantly with obligate anaerobes, was commonly observed in preoperative blood samples. In addition to the previously known risk factors, O-BT may be one of the risk factors for SSIs following pancreatoduodenectomy.
BACKGROUND: Occult-bacterial translocation (O-BT) has been reported as the condition in which microorganisms are detected in blood or lymph node by a highly sensitive method. However, the clinical impact of preoperative O-BT on postoperative complications is unclear. STUDY DESIGN: A prospective observational study with patients undergoing pancreatoduodenectomy for periampullary diseases was conducted. Blood samples were collected immediately after the induction of anesthesia. The status of O-BT was investigated using bacterium-specific ribosomal RNA-targeted reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR). The impact of O-BT on surgical site infections (SSIs) was analysed. RESULTS: A total of 155 patients were included. The positive rate in preoperative blood samples detected by RT-qPCR was significantly higher than that obtained by the culture method (32 of 155 vs 4 of 155, p<0.001). Preoperative blood samples were contaminated with 1.0 to 19.2 bacterial cells/mL in positive patients, and 30 of the 41 detected microorganisms were obligate anaerobes. No differences in preoperative factors were observed between patients with positive and negative RT-qPCR results. The incidence of any SSI was significantly higher in patients with contaminated preoperative blood (≥1.2 bacterial cells/mL) than in other patients (14 of 27 vs 35 of 128, p=0.013). Multivariable analysis indicated that contaminated preoperative blood was identified as one of the independent risk factors for SSIs (odds ratio 2.71, 95% CI 1.04 to 7.24, p=0.041). CONCLUSIONS:O-BT, predominantly with obligate anaerobes, was commonly observed in preoperative blood samples. In addition to the previously known risk factors, O-BT may be one of the risk factors for SSIs following pancreatoduodenectomy.