Association between gastric Candida colonization and surgical site infections after high-level hepatobiliary pancreatic
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ORIGINAL ARTICLE
Association between gastric Candida colonization and surgical site infections after high-level hepatobiliary pancreatic surgeries: the results of prospective observational study Kazuyuki Gyoten 1 & Hiroyuki Kato 1 & Aoi Hayasaki 1 & Takehiro Fujii 1 & Yusuke Iizawa 1 & Yasuhiro Murata 1 & Akihiro Tanemura 1 & Naohisa Kuriyama 1 & Masashi Kishiwada 1 & Shugo Mizuno 1 & Masanobu Usui 1 & Hiroyuki Sakurai 1 & Shuji Isaji 1 Received: 25 April 2020 / Accepted: 1 October 2020 # The Author(s) 2020
Abstract Aim High-level hepatobiliary pancreatic (HBP) surgeries are highly associated with surgical site infections (SSIs), in which microorganisms have a significant role. In the present study, we investigated whether gastric Candida colonization had a significant role in SSIs after high-level HBP surgeries. Methods Between May 2016 and February 2017, the 66 patients who underwent high-level HBP surgeries were enrolled in the present study. The gastric juice was prospectively collected through nasogastric tube after general anesthesia induction and was incubated onto the CHROMagar Candida plate for the cultivation of various Candida species. First of all, we compared the incidence of SSIs according to the presence or absence of Candida species in gastric juice. Secondly, we evaluated the variables contributing to the development of SSIs by multivariate analysis. The protocol was approved by the medical ethics committee of Mie University Hospital (No.2987). Results Gastric Candida colonization was identified in 21 patients (group GC) and was not identified in the other 45 patients (group NGC). There were no differences in preoperative variables including compromised status, such as age, nutritional markers, complications of diabetes mellitus, and types of primary disease between the two groups. SSIs occurred in 57.1% (12/21) of group GC and in 17.8% (8/45) of group NGC, showing a significant difference (p = 0.001). Multivariate analysis revealed gastric Candida colonization as a significant risk factor of SSIs (OR 6.17, p = 0.002). Conclusion Gastric Candida colonization, which is not a result of immunocompromised status, is highly associated with SSIs after high-level HBP surgeries. Trial registration Japan Primary Registries Network; UMIN-CTR ID: UMIN000040486 (retrospectively registered on 22nd May, 2020). Keywords Candida . Gastric juice . Hepatobiliary pancreatic surgeries . Surgical site infections
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-02006-7) contains supplementary material, which is available to authorized users. * Hiroyuki Kato [email protected] 1
Department of Hepatobiliary Pancreatic and Transplant Surgery, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 514-0001, Japan
High-level hepatobiliary pancreatic (HBP) surgeries such as major hepatectomy and pancreaticoduodenectomy (PD) are associated with a high incidence of morbidity and mortality despite advanced surgical techniques and postoperat
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