Mortality analysis of Aeromonas hydrophila infection in hepato-biliary pancreatic surgery: Multicenter retrospective observational study
Corresponding Author
Masaki Ueno
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
Correspondence
Masaki Ueno, Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan.
Email: [email protected]
Search for more papers by this authorHiroya Iida
Department of Surgery, Shiga University of Medical Science, Otsu, Japan
Search for more papers by this authorMasaki Kaibori
Department of Surgery, Kansai Medical University Hirakata Hospital, Hirakata, Japan
Search for more papers by this authorKoji Komeda
Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
Search for more papers by this authorShigekazu Takemura
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
Search for more papers by this authorTakehiro Noda
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
Search for more papers by this authorHisashi Ikoma
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Search for more papers by this authorTakeo Nomi
Department of Surgery, Nara Medical University, Kashihara, Japan
Search for more papers by this authorShinya Hayami
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
Search for more papers by this authorFumitoshi Hirokawa
Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
Search for more papers by this authorShogo Tanaka
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
Search for more papers by this authorKousuke Matsui
Department of Surgery, Kansai Medical University Hirakata Hospital, Hirakata, Japan
Search for more papers by this authorMorihiko Ishizaki
Department of Surgery, Kansai Medical University Hirakata Hospital, Hirakata, Japan
Search for more papers by this authorRyo Morimura
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Search for more papers by this authorDaisuke Hokuto
Department of Surgery, Nara Medical University, Kashihara, Japan
Search for more papers by this authorHidetoshi Eguchi
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
Search for more papers by this authorMasaji Tani
Department of Surgery, Shiga University of Medical Science, Otsu, Japan
Search for more papers by this authorHiroki Yamaue
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
Search for more papers by this authorShoji Kubo
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
Search for more papers by this authorCorresponding Author
Masaki Ueno
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
Correspondence
Masaki Ueno, Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan.
Email: [email protected]
Search for more papers by this authorHiroya Iida
Department of Surgery, Shiga University of Medical Science, Otsu, Japan
Search for more papers by this authorMasaki Kaibori
Department of Surgery, Kansai Medical University Hirakata Hospital, Hirakata, Japan
Search for more papers by this authorKoji Komeda
Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
Search for more papers by this authorShigekazu Takemura
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
Search for more papers by this authorTakehiro Noda
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
Search for more papers by this authorHisashi Ikoma
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Search for more papers by this authorTakeo Nomi
Department of Surgery, Nara Medical University, Kashihara, Japan
Search for more papers by this authorShinya Hayami
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
Search for more papers by this authorFumitoshi Hirokawa
Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
Search for more papers by this authorShogo Tanaka
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
Search for more papers by this authorKousuke Matsui
Department of Surgery, Kansai Medical University Hirakata Hospital, Hirakata, Japan
Search for more papers by this authorMorihiko Ishizaki
Department of Surgery, Kansai Medical University Hirakata Hospital, Hirakata, Japan
Search for more papers by this authorRyo Morimura
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Search for more papers by this authorDaisuke Hokuto
Department of Surgery, Nara Medical University, Kashihara, Japan
Search for more papers by this authorHidetoshi Eguchi
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
Search for more papers by this authorMasaji Tani
Department of Surgery, Shiga University of Medical Science, Otsu, Japan
Search for more papers by this authorHiroki Yamaue
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
Search for more papers by this authorShoji Kubo
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
Search for more papers by this authorUeno and Iida equally contributed to this study.
Abstract
Background/Purpose
Aeromonas hydrophila can cause lethal infectious complications after surgery. There have been no large cohort studies of this specific to the hepato-biliary-pancreatic (HBP) field. We investigate the postoperative influence of A hydrophila infection after HBP surgery.
Methods
We retrospectively reviewed patients who underwent HBP surgery between 2008 and 2017 at eight university hospitals. Patients with A hydrophila isolation during perioperative management were extracted, and their postoperative courses were investigated.
Results
Bacterial culture examination of 10 074 patients was performed as perioperative management. Among them, 76 patients (0.75%) had A hydrophila isolation, most of whom underwent pancreatoduodenectomy (n = 38) or hepatectomy with biliary reconstruction (n = 14). There were seven mortalities after these two procedures (13.5%), five within 3 days after the onset of infection. Bile (n = 48) and abdominal drainage fluid (n = 29) were major sites of A hydrophila isolation. Typical prophylactic antibiotics, cefazolin or flomoxef, were mostly resistant. There was no mortality among patients that received sensitive antibiotics prophylactically.
Conclusions
Isolation of A hydrophila was low in our cases of HBP surgery, but the condition of some patients deteriorated rapidly by this infection. Although there could be several bacterial infections during management of HBP surgery, A hydrophila should not be overlooked. Preparation of appropriate prophylactic antibiotics may prevent or reduce mortality.
CONFLICT OF INTEREST
All authors declare no conflict of interest for this article.
REFERENCES
- 1Schindl MJ, Redhead DN, Fearon KC, Garden OJ, Wigmore SJ, Edinburgh Liver S, et al. The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut. 2005; 54: 289–96.
- 2Peluso H, Jones WB, Parikh AA, Abougergi MS. Treatment outcomes, 30-day readmission and healthcare resource utilization after pancreatoduodenectomy for pancreatic malignancies. J Hepato-Biliary-Pancreatic Sci. 2019; 26: 187–94.
- 3Toh HS, Chuang YC, Huang CC, Lee YL, Liu YM, Ho CM, et al. Antimicrobial susceptibility profiles of Gram-negative bacilli isolated from patients with hepatobiliary infections in Taiwan: results from the Study for Monitoring Antimicrobial Resistance Trends (SMART), 2006–2010. Int J Antimicrob Agents. 2012; 40(Suppl): S18–S23.
- 4Kwon W, Jang JY, Kim EC, Park JW, Han IW, Kang MJ, et al. Changing trend in bile microbiology and antibiotic susceptibilities: over 12 years of experience. Infection. 2013; 41: 93–102.
- 5Sha J, Kozlova EV, Chopra AK. Role of various enterotoxins in Aeromonas hydrophila-induced gastroenteritis: generation of enterotoxin gene-deficient mutants and evaluation of their enterotoxic activity. Infect Immun. 2002; 70: 1924–35.
- 6Tsai GJ, Chen TH. Incidence and toxigenicity of Aeromonas hydrophila in seafood. Int J Food Microbiol. 1996; 31: 121–31.
- 7Vukmir RB. Aeromonas hydrophila: myofascial necrosis and sepsis. Intensive Care Med. 1992; 18: 172–4.
- 8Ramsay AM, Rosenbaum BJ, Yarbrough CL, Hotz JA. Aeromonas hydrophila sepsis in a patient undergoing hemodialysis therapy. JAMA. 1978; 239: 128–9.
- 9Reines HD, Cook FV. Pneumonia and bacteremia due to Aeromonas hydrophila. Chest. 1981; 80: 264–7.
- 10Murata H, Yoshimoto H, Masuo M, Tokuda H, Kitamura S, Otsuka Y, et al. Fulminant pneumonia due to Aeromonas hydrophila in a man with chronic renal failure and liver cirrhosis. Intern Med. 2001; 40: 118–23.
- 11Okamura K, Tanaka K, Miura T, Nakanishi Y, Noji T, Nakamura T, et al. Randomized controlled trial of perioperative antimicrobial therapy based on the results of preoperative bile cultures in patients undergoing biliary reconstruction. J Hepato-Biliary-Pancreatic Sci. 2017; 24: 382–93.
- 12Tena D, Gonzalez-Praetorius A, Gimeno C, Perez-Pomata MT, Bisquert J. [Extraintestinal infection due to Aeromonas spp.: review of 38 cases]. Enferm Infecc Microbiol Clin. 2007; 25: 235–41.
- 13Kneuertz PJ, Pitt HA, Bilimoria KY, Smiley JP, Cohen ME, Ko CY, et al. Risk of morbidity and mortality following hepato-pancreato-biliary surgery. J Gastrointest Surg. 2012; 16: 1727–35.
- 14Otsubo T, Kobayashi S, Sano K, Misawa T, Ota T, Katagiri S, et al. Safety-related outcomes of the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons. J Hepato-Biliary-Pancreatic Sci. 2017; 24: 252–61.
- 15Sugawara G, Ebata T, Yokoyama Y, Igami T, Takahashi Y, Takara D, et al. The effect of preoperative biliary drainage on infectious complications after hepatobiliary resection with cholangiojejunostomy. Surgery. 2013; 153: 200–10.
- 16Mussle B, Hempel S, Kahlert C, Distler M, Weitz J, Welsch T. Prognostic impact of bacterobilia on morbidity and postoperative management after pancreatoduodenectomy: a systematic review and meta-analysis. World J Surg. 2018; 42: 2951–62.
- 17Ishida T, Miyazaki K, Hikone M, Sugiyama K, Tanabe T, Hamabe Y. Successful support by veno-arterial extracorporeal membrane oxygenation for severe septic shock caused by Aeromonas hydrophila. Acute Med Surg. 2019; 6: 305–7.
- 18Yumoto T, Ichiba S, Umei N, Morisada S, Tsukahara K, Sato K, et al. Septic shock due to Aeromonas hydrophila bacteremia in a patient with alcoholic liver cirrhosis: a case report. J Med Case Rep. 2014; 8: 402.
- 19Ejaz A, Schmidt C, Johnston FM, Frank SM, Pawlik TM. Risk factors and prediction model for inpatient surgical site infection after major abdominal surgery. J Surg Res. 2017; 217: 153–9.
- 20Wu CJ, Wu JJ, Yan JJ, Lee HC, Lee NY, Chang CM, et al. Clinical significance and distribution of putative virulence markers of 116 consecutive clinical Aeromonas isolates in southern Taiwan. J Infect. 2007; 54: 151–8.
- 21Llopis F, Grau I, Tubau F, Cisnal M, Pallares R. Epidemiological and clinical characteristics of bacteraemia caused by Aeromonas spp. as compared with Escherichia coli and Pseudomonas aeruginosa. Scand J Infect Dis. 2004; 36: 335–41.
- 22Ko WC, Lee HC, Chuang YC, Liu CC, Wu JJ. Clinical features and therapeutic implications of 104 episodes of monomicrobial Aeromonas bacteraemia. J Infect. 2000; 40: 267–73.
- 23Sudo T, Murakami Y, Uemura K, Hashimoto Y, Kondo N, Nakagawa N, et al. Perioperative antibiotics covering bile contamination prevent abdominal infectious complications after pancreatoduodenectomy in patients with preoperative biliary drainage. World J Surg. 2014; 38: 2952–9.
- 24Sano S, Sugiura T, Kawamura I, Okamura Y, Ito T, Yamamoto Y, et al. Third-generation cephalosporin for antimicrobial prophylaxis in pancreatoduodenectomy in patients with internal preoperative biliary drainage. Surgery. 2019; 165: 559–64.
- 25Ko WC, Wu HM, Chang TC, Yan JJ, Wu JJ. Inducible beta-lactam resistance in Aeromonas hydrophila: therapeutic challenge for antimicrobial therapy. J Clin Microbiol. 1998; 36: 3188–92.
- 26Rhee JY, Jung DS, Peck KR. Clinical and therapeutic implications of Aeromonas bacteremia: 14 years nation-wide experiences in Korea. Infect Chemother. 2016; 48: 274–84.
- 27Tsai YH, Chen PH, Yu PA, Chen CL, Kuo LT, Huang KC. A multiplex PCR assay for detection of Vibrio vulnificus, Aeromonas hydrophila, methicillin-resistant Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus agalactiae from the isolates of patients with necrotizing fasciitis. Int J Infect Dis. 2019; 81: 73–80.
- 28Puah SM, Khor WC, Kee BP, Tan J, Puthucheary SD, Chua KH. Development of a species-specific PCR-RFLP targeting rpoD gene fragment for discrimination of Aeromonas species. J Med Microbiol. 2018; 67: 1271–8.
- 29Grim CJ, Kozlova EV, Ponnusamy D, Fitts EC, Sha J, Kirtley ML, et al. Functional genomic characterization of virulence factors from necrotizing fasciitis-causing strains of Aeromonas hydrophila. Appl Environ Microbiol. 2014; 80: 4162–83.
- 30Yamasaki O, Takahashi E, Noda K, Kanaya N, Tanabe S, Shirakawa Y, et al. Surgical site infection caused by Aeromonas hydrophila presenting as necrotizing soft tissue infection after esophagectomy. J Dermatol. 2020; 47: 673–6.
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