Epidemiology and risks for infection following cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy.

Tytuł:: Epidemiology and risks for infection following cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy.
Autorzy:: Smibert OC; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Grattan Street, Melbourne, VIC, 3000, Australia. .
Slavin MA; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Grattan Street, Melbourne, VIC, 3000, Australia.
Teh B; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Grattan Street, Melbourne, VIC, 3000, Australia.
Heriot AG; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
Penno J; Division of Pharmacy, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
Ismail H; Department of Cancer Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
Thursky KA; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Grattan Street, Melbourne, VIC, 3000, Australia.
Worth LJ; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Grattan Street, Melbourne, VIC, 3000, Australia.
Źródło:: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer [Support Care Cancer] 2020 Jun; Vol. 28 (6), pp. 2745-2752. Date of Electronic Publication: 2019 Nov 12.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: Berlin : Springer International, c1993-
MeSH Terms:: Cytoreduction Surgical Procedures/*adverse effects
Digestive System Surgical Procedures/*adverse effects
Hyperthermia, Induced/*adverse effects
Surgical Wound Infection/*epidemiology
Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/surgery ; Combined Modality Therapy ; Cytoreduction Surgical Procedures/methods ; Female ; Humans ; Hyperthermia, Induced/methods ; Male ; Middle Aged ; Peritoneal Neoplasms/surgery ; Pseudomyxoma Peritonei/surgery ; Retrospective Studies ; Surgical Wound Infection/microbiology ; Young Adult
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Contributed Indexing:: Keywords: CRS-HIPEC; Infection; Surgical site infection
Entry Date(s):: Date Created: 20191113 Date Completed: 20200629 Latest Revision: 20220421
Update Code:: 20240105
DOI:: 10.1007/s00520-019-05093-5
PMID:: 31712951
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Background: CRS-HIPEC is associated with improved cancer survival but an increased risk of infection.
Methods: Consecutive patients undergoing CRS-HIPEC between January 2016 and May 2018 were retrospectively reviewed. Malignancy type, comorbidities, perioperative risk factors and infectious complications were captured, using standardised definitions. Association between risk factors and infection outcomes was evaluated by logistic regression modelling.
Results: One-hundred patients underwent CRS-HIPEC, predominantly for colorectal cancer and pseudomyxoma peritonei. Overall, 43 (43.0%) experienced an infectious complication, including infections at surgical site (27), respiratory tract (9), urinary tract (11), Clostridium difficile (2) and post-operative sepsis (15). In most, infection onset was within 7 days post-operatively. Median length of hospitalisation was 19 days for patients with infection, compared to 8 days for those without (p = 0.000). There were no deaths at 60 days. Of variables potentially associated with surgical site infection, small bowel resection (OR 4.01, 95% confidence interval [CI] 1.53-10.83; p = 0.005) and number of resected viscera (OR 1.41, 95% CI 1.00-1.98; p = 0.048) were significantly associated with infection.
Conclusions: We demonstrate a significant burden of early infective complications in patients undergoing CRS-HIPEC. Higher-risk subgroups, including those with small bowel resection and increased number of resected viscera, may benefit from enhanced monitoring.

Comment in: Support Care Cancer. 2021 Aug;29(8):4179-4180. (PMID: 33438052)
Comment in: Support Care Cancer. 2021 Aug;29(8):4181-4182. (PMID: 34028617)

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