Correlation Between Indwelling Time Of Abdominal Drainage Tube And Retrograde Infection At Surgical Site

Background:In order to detect postoperative complications as soon as possible and reduce morbidity and mortality,abdominal drainage tubes are often used prophylactically.At present,Enhanced Recovery After Surgery（ERAS）advocates early removal of abdominal drainage tube and irregular placement of abdominal drainage tube.Abdominal drainage tube can be used as a channel for retrograde bacterial infection,resulting in organ/space surgical site infection.Objective:The purpose of this study was to explore the relationship between the indwelling time of catheter and the bacterial infection rate of drainage fluid,and to clarify the effect of indwelling time of prophylactic abdominal drainage tube on the development of retrograde infection in organ/space operation site.Data&Methods:1.A retrospective cohort analysis was conducted on patients who underwent surgery in the Department of Hepatobiliary Pancreatic and splenic surgery of the first people’s Hospital of Guangzhou from February 2019 to March 2020.2.Mantel-Haenszel chi-square test（linear trend test）was used to analyze the relationship between indwelling time of abdominal drainage tube and bacterial infection rate of drainage fluid.3.The bacterial infection rate and various microbial infection rates of abdominal drainage fluid in early extubation group and late extubation group were compared.4.The baseline data,preoperative and postoperative indexes of bacterial infection positive group and negative group were compared,and the independent risk factors of bacterial infection in abdominal drainage fluid were determined by binary Logistic regression analysis.5.The baseline data,preoperative and postoperative indexes of biliary fistula group and non-biliary fistula group were compared,and the independent risk factors of biliary fistula were determined by binary Logistic regression analysis.6.The bacterial infection rate of drainage fluid and the infection rate of various microbial species in biliary fistula group and non-biliary fistula group were compared.Results:1.A total of 200 patients were included for analysis,and 45 cases had bacterial infection in abdominal drainage fluid.Enterococcus faecalis and Enterococcus faecium were the main types of bacterial infection in the drainage fluid,accounting for about 40%,followed by Escherichia coli and Pseudomonas aeruginosa,and other bacteria accounted for about 15.55%.2.Analysis of bacterial infection rate in abdominal drainage fluid of200 patients with catheterization time:Mantel-haenszel chi-square test（n=200）:χ²_trend=18.070,P_trend<0.05,showed that there was a linear relationship between the catheterization time and the positive rate of bacterial culture of drainage fluid;Person-related results R=0.301,showed that the positive rate of bacterial culture increased with the increase of days.Similarly,in patients with hepatectomy（n=44）and choledocholithotomy（n=86）,there was a linear relationship between the time of catheterization and the bacterial infection rate of abdominal drainage fluid,and the bacterial infection rate of drainage fluid increased with the increase of catheterization time.3.Analysis of bacterial infection rate in abdominal drainage fluid of53 patients undergoing Cholecystectomy with Catheterization time:Mantel-haenszel chi-square test（n=53）:χ²_trend=3.138,P_trend>0.05,showed that there was no obvious linear relationship between the days of catheterization and the positive rate of bacterial culture of drainage fluid,which may be due to the small sample size.Fisher accurate probability analysis showed that the positive rate of bacterial culture was significantly different with different catheterization time.The positive rate of bacterial culture in more than 7 days was significantly higher than that in 1-2 days and 3-4 days,suggesting that the positive rate of bacterial culture increased after indwelling catheterization for a long time（P=0.028）.4.190 patients undergoing hepatobiliary surgery were divided into early extubation group（<5 days,n=102）and late extubation group（≧5 days,n=88）according to the time of catheterization.The infection rates of bacteria,enterococci and Escherichia coli in abdominal drainage fluid in the late extubation group were significantly higher than those in the early extubation group（P<0.05）.5.190 patients undergoing hepatobiliary surgery were divided into positive group（n=43）and negative group（n=147）according to the results of bacterial infection in abdominal drainage fluid.Logistic multivariate analysis showed that compared≧5 days with<5 days,the risk of abdominal drainage fluid infection increased（OR=5.02,95%CI:（2.28,11.03）,P<0.05）.Therefore,the catheterization time of more than 5 days is an independent risk factor for retrograde infection of postoperative abdominal drainage fluid.6.197 patients who underwent hepatobiliary surgery were divided into the biliary fistula group（n=7）and the non-biliary fistula group（n=190）according to whether biliary fistula occurred.Logistic multivariate analysis showed that the increased ratio of POD 1 drainage fluid to serum total bilirubin resulted in increased risk of biliary fistula（OR=4.26,95%CI（1.56,11.64）,P<0.05）.Therefore,the high ratio of POD-1 drainage fluid to serum total bilirubin is an independent risk factor for biliary fistula.7.For hepatectomy（n=48）,Candida albicans was significantly higher in patients with biliary fistula（P=0.005）.For choledocholithotomy by exploration of common bile duct（n=89）,there was no significant difference in the bacterial infection rate of drainage fluid and the infection rate of various microbial species between patients with fistula and those without fistula（P>0.05）.Conclusions:1.With the prolongation of the indwelling time of prophylactic abdominal drainage tube,the infection of organ/space operation site increased significantly.It is suggested that the unnecessary preventive abdominal drainage tube should be removed as soon as possible within 5days after operation,which can help to reduce the retrograde infection of organ/space operation site.2.The ratio of POD-1 drainage fluid to serum total bilirubin can be used as an important index to predict the occurrence of biliary fistula after hepatobiliary surgery.It is helpful to identify patients with high risk of biliary fistula earlier,make early diagnosis and treatment intervention,and may allow unnecessary preventive abdominal drainage tube to be removed as soon as possible.3.The presence of Candida albicans in drainage fluid may be related to the occurrence of biliary fistula after hepatectomy.