Influencing factors and preventive measures of infectious complications after intestinal resection for Crohn’s disease

The incidence of Crohn’s disease(CD)has increased in recent years,with most patients requiring intestinal resection.Complications after intestinal resection for CD can lead to poor prognosis and recurrence,among which infectious complic-ations are the most common.This study aimed to investigate the common risk factors,including medications,preoperative nutritional status,surgery-related factors,microorganisms,lesion location and type,and so forth,causing infectious complications after intestinal resection for CD,and to propose corresponding preventive measures.The findings provided guidance for identifying suscept-ibility factors and the early intervention and prevention of infectious complic-ations after intestinal resection for CD in clinical practice.

The impacts of infectious complications on outcomes in acute pancreatitis: a retrospective study

Background: The occurrence of infectious complications characterizes the more severe forms of acute pancreatitis(AP) and is associated with high mortality. We investigated the effects of infection at different sites in patients with AP, including those with necrotizing pancreatitis(NP).Methods: We conducted a retrospective analysis of 285 patients who met the inclusion criteria for AP and were admitted to Tianjin Nankai Hospital between January 2016 and September 2019. According to the source of the culture positivity during hospitalization, patients were divided into four groups: sterile group(n=148), pancreatic infection group(n=65), extrapancreatic infection group(n=22) and combined infection group(n=50). The source of infection, microbiology, biochemical parameters and prognostic indicators were analyzed.Results: In terms of baseline characteristics, the four groups were similar in age, sex, aetiology, previous pancreatitis and diabetes. Compared with the severity of the disease in the other groups, the APACHE II scores(9.91±4.65, 9.46±5.05, respectively) and organ failure rate(40.9% and 50%, respectively)were higher in the extrapancreatic infection group and the combined infection group(P<0.05). The frequency of surgical intervention and hospitalization time in patients with NP complicated with extrapancreatic infection was greatly increased(P<0.05). Regarding the primary outcome, patients in the combined infection group had longer hospital stays(68.28±51.80 vs. 55.58±36.24, P<0.05) and higher mortality(24.0% vs. 9.2%, P<0.05) than patients in the pancreatic infection group. In addition, patients in the extrapancreatic infection group also showed high intensive care utilization(59.1%) and mortality rates(18.2%). Among the 137 AP patients with infection complications, 89 patients exhibited multidrug-resistant(MDR) microorganisms, and the mortality rate of patients with MDR bacterial infection was higher than that of patients with non-MDR bacterial infection(24.7% vs. 3.6%, P=0.001).Conclusions: Clinicians should be aware that extrapancreatic infection(EPI) significantly aggravates the main outcome in pancreatic infection patients. Infection with MDR bacteria is also associated with AP mortality.

Perioperative blood transfusion is associated with post-operative infectious complications in patients with Crohn’s disease

Background:We have previously demonstrated that blood transfusion(BT)was associated with post-operative complications in patients undergoing surgery for Crohn’s disease(CD),based on our institutional data registry.The aim of this study was to verify the association between perioperative BT and infectious complications in CD patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program(ACS NSQIP)database.Methods:All CD patients undergoing surgery between 2005 and 2013 were identified from NSQIP.Variables were defined according to the ACS NSQIP guidelines.The primary outcome was infectious complications,including superficial,deep and organ/space surgical site infection,wound dehiscence,urinary tract infection,pneumonia,systemic sepsis and septic shock.Multivariate analyses were performed to assess the risk factors for post-operative infections.Results:All 10100 eligible patients were included and 611(6.0%)received perioperative BT.BT patients were older,lighter in weight and more likely to be functionally dependent.BT patients were more likely to have post-operative infectious complications than those without BT,including superficial surgical site infection(SSI)(10.8%vs 7.4%,p¼0.002),deep SSI(3.3%vs 1.6%,p¼0.003),organ/space SSI(14.2%vs 5.4%,p<0.001),pneumonia(3.8%vs 1.3%,p<0.001),urinary tract infection(3.9%vs 2.2%,p¼0.006),sepsis(11.5%vs 4.5%,p<0.001)and sepsis shock(3.1%vs 0.8%,p<0.001).Multivariate analysis showed that intra-and/or post-operative BT was an independent risk factor for post-operative infectious complications(odds ratio[OR]¼2.2;95%confidence interval[CI]:1.8–2.7;p<0.001)and the risk increased with each administered unit of red blood cell(OR¼1.3,95%CI:1.2–1.5).Other independent factors were history of smoking,chronic heart disease,diabetes,hypertension and the use of corticosteroids.Pre-operative BT,however,was not found to be a risk factor to post-operative infections.Conclusions:Intra-and/or post-operative,not pre-operative,BT was found to be associated with an increased risk for postoperative infectious complications in this CD cohort.Therefore,the timing and risks and benefits of BT should be carefully balanced.

Early selective enteral feeding in treatment of acute pancreatitis: A case report

BACKGROUND Early initiation of enteral feeding is recognized to play a crucial role in improving the outcomes of treatment of acute pancreatitis.However,the method of adminis-tration of enteral nutrition remains debatable.We present the experience of treating a patient with moderate-severe acute pancreatitis,at high risk of progressing to a severe or fatal condition,using a novel method of selective feeding with duodenal isolation.CASE SUMMARY A 27-year-old female patient presented to the emergency unit of the hospital with a typical manifestation of acute pancreatitis.Despite a conventional treatment,the patient’s condition deteriorated by day 2 of hospitalization.Using an endoscopic approach,a novel catheter PandiCathffwas placed to the duodenum of the patient,isolating its segment between the duodenal bulb and the ligament of Treitz.In the isolated area created,a negative pressure was applied,followed by introduction of early selective enteral feeding.The patient’s condition subsequently improved in a rapid manner,and no complications often associated with moderate-to-severe acute pancreatitis developed.CONCLUSION Within 48 h of starting treatment with the novel method,it can prevent the development of multiple organ failure and,when combined with minimally invasive drainage methods,help prevent infection.

Infective Endocarditis in Chronic Hemodialysis Patients: Specificities and Therapeutic Management

Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are the main predisposing factors for these patients to develop IE. We aimed to highlight the clinical and microbiological specificities of IE in CHD patients, detail the therapeutic management in these patients and identify the risk factors for in-hospital mortality. We included 28 CHD patients in whom the diagnosis of IE was established according to modified Duke criteria. The mean age was 47 ± 17 years. Among them, 57% were hypertensive and 39% were diabetic. The average duration of hemodialysis was 3.5 ± 7 years. The vascular access was a tunnelled jugular catheter, arteriovenous fistula, and temporary catheter in 54%, 28%, and 18% of patients, respectively. Half of the patients presented with heart failure at admission. Methicillin-sensitive Staphylococcus is the most commonly implicated pathogen. Transthoracic echocardiography revealed vegetation in all patients. In 60% of cases, the lesion is located on the mitral valve, and in 35% it is on the tricuspid valve. Patients initially received empirical antibiotic therapy, which was adjusted according to bacteriological results. Valve surgery was indicated in 12 patients, with aortic valve replacement being the most performed procedure followed by tricuspid annuloplasty. The in-hospital mortality rate was 32%. Factors associated with mortality were severe mitral insufficiency (p = 0.036), heart failure (p = 0.043), and the presence of Methicillin-resistant Staphylococcus in blood cultures (p = 0.047). IE is a complication with high morbidity and mortality. Its increasing incidence, specificities in chronic CHD patients, and the complexity of its management require a rigorous preventive strategy. A multidisciplinary collaboration between nephrologists, infectious disease specialists, cardiologists, and surgeons is crucial to optimize therapeutic management.

Effect of perioperative blood transfusion on clinical outcomes in hepatic surgery for cancer

Allogeneic blood transfusion during liver resection for malignancies has been associated with an increased incidence of different types of complications: infectious complications, tumor recurrence, decreased survival. Even if there is clear evidence of transfusion-induced immunosuppression, it is difficult to demonstrate that transfusion is the only determinant factor that decisively affects the outcome. In any case there are several motivations to reduce the practice of blood transfusion. The advantages and drawbacks of different transfusion alternatives are reviewed here, emphasizing that surgeons and anesthetists who practice in centers with a high volume of liver resections, should be familiar with all the possible alternatives.

Disseminated herpes simplex infection induced hepatitis during pregnancy mimicking HELLP syndrome,a diagnostic challenge

The disseminated herpes simplex virus 2(HSV-2)carries a high mortality rate in pregnant women if left unrec-ognized.It often presents as unrelieved fever and hepatitis.Diagnosis is challenging due to vague symptoms and potential overlap with other conditions.Pregnancy is a risk factor as it conforms to a partially immunocompro-mised state.Dissemination to the brain could be devastating,and the treatment requires intravenous antivirals like acyclovir.Fetal outcomes are variable based on previous case reports.We present a case of young female gravida 1 para 1 who presented with disseminated HSV infection mimicking HELLP(Hemolysis,Elevated Liver enzymes,and Low Platelets)syndrome.She responded well to intravenous acyclovir,and the fetus had a viable outcome at the 26th week of gestation.Early diagnosis can prevent progression to fulminant liver failure and the need for a liver transplant.

Diagnostic value of human cytomegalovirus late mRNA detection in active intrauterine infection

OBJECTIVE: To study the diagnostic value of human cytomegalovirus (HCMV) late mRNA detection in active intrauterine infection. METHODS: The HCMV late mRNA in peripheral blood of 42 HCMV IgM positive pregnant women and their fetal attachments (such as chorionic villi, amniotic fluid, umbilical blood and placenta) were detected by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Late mRNA was detected in 23 of 42 HCMV IgM positive cases, a rate of 54.3%. Fetal appendages in 13 cases of late mRNA positive mothers were also tested, of which 7 were positive, with a vertical transmission rate of 53.8%. In 12 late mRNA negative mothers, only 1 case of fetal appendages tested was positive, with a vertical transmission rate of 8.3%. There was significant difference between the transmission rates of these two groups. CONCLUSIONS: Positive results of HCMV IgM cannot accurately reflect the activity of HCMV at the time of testing. However, the activity of HCMV is closely related to the mother-fetus vertical transmission rate. As an indicator of active HCMV infection, late mRNA can not only reflect the mother-fetus transmission rate during active HCMV infection, but also provide some information about HCMV activity in fetal tissue.