Etiology,Drug Resistance And Influencing Factors Analysis Of Peritoneal Infection In Patients With Primary Hepatic Carcinoma Resection

Ⅰ PurposeThe etiology,resistance profiles and factors inducing abdominal infection were analyzed retrospectively by collecting the pathogenic samples,the corresponding results of susceptibility test and the information of patients with postoperative abdominal infection of primary liver cancer in Mengchao Hepatobiliary Hospital of Fujian Medical University.Meanwhile,the prevalence of carbapenem-resistant Escherichia coli in the samples of abdominal infection in patients with primary liver cancer after the operation was monitored.The carbapenem suspectable and resistant strains were selected to analyze,respectively.The drug-resistant genes of the strains were identified and analyzed by whole gene sequencing.In this study,we hoped to provide evidence-based medical evidence for the formulation of empirical antibacterial treatment for patients with postoperative abdominal infection of primary liver cancer and design the corresponding preventive countermeasures in clinical practice,which will reduce the incidence of postoperative abdominal infection of primary liver cancer.Through monitoring and analyzing the correlation of resistance genes among carbapenem-resistant Escherichia coli strains,it hopefully could provide a theoretical basis for effectively reducing the spread and prevalence of resistant strains and nosocomial infection in hospital.Ⅱ Methods1 Etiology and drug resistance of pathogen isolated from patients with postoperative abdominal infection of primary hepatic carcinoma resection(1)According to the clinical diagnostic criteria,the inclusion criteria and exclusion criteria of clinical cases were formulated to screen patients with postoperative abdominal infection of primary liver cancer.(2)The information of pathogenic diagnosis and drug susceptibility of the strains collected from patients were statistically analyzed by hospital HIS and LIS systems.Vitek-2 compact automatic microbial identification and drug susceptibility analysis system(France Merier company)was used to detect the drug susceptibility of pathogens.2 Analysis of influencing factors of postoperative abdominal infection in patients with primary hepatic carcinoma resection(1)The clinical information of patients was collected through the hospital HIS system.The clinical data of patients with postoperative abdominal infection of primary liver cancer were collected,including general indexes,ultrasonic indexes,biochemical indexes,and so on.The contents are as follows:(1)General demographic characteristics: height,weight,body mass index(BMI),gender and age;(2)Combined basic diseases: including whether combined with hypertension,diabetes,etc;(3)Ultrasonic examination indexes(within one week before operation): tumor location and maximum tumor diameter;(4)Operation indexes: operation duration,intraoperative blood transfusion,intraoperative bleeding,placement time of abdominal drainage tube;(5)Laboratory indexes(collected within three days before operation): hemoglobin(Hgb),alanine aminotransferase(ALT),aspartate aminotransferase(AST),platelet count(PLT),albumin(ALB),prothrombin time(PT),Tumor markers include alpha-fetoprotein(AFP)、carbohydrate antigen 19-9(CA19-9)and abnormal prothrombin.(2)To screen the risk factors of abdominal infection after operation for primary liver cancer(1)Univariate analysis was used to screen the risk factors of abdominal infection after resection of primary liver cancer;(2)The multivariate analysis of postoperative abdominal infection of primary liver cancer was carried out by binary logistic regression model.Taking the occurrence of postoperative abdominal infection as the dependent variable and all influencing indicators as independent variables,they were included in the logistic regression model to further verify the results of univariate analysis and screen out the possible risk factors of postoperative abdominal infection of primary liver cancer.3 Analysis of whole gene sequencing of carbapenem-resistant Escherichia coliThe whole gene sequencing of carbapenem-resistant and sensitive Escherichia coli was carried out to clarify the related genes of carbapenem resistance and the related effects of gene expression on drug resistance,compare the gene characteristics with the control group of sensitive strains and identify the differences between these strains.Ⅲ Results1 The pathogenic bacteria of postoperative abdominal infection in patients with primary liver cancer in Mengchao Hepatobiliary Hospital are mainly Enterobacteriaceae and non-fermenting bacteria,and Enterococcus and Staphylococcus are common positive bacteria.The results of this study have a certain degree of reference significance for a timely,effective,and accurate grasp of the distribution of pathogens of abdominal infection and clinical anti-infection experience and medication guidance in our hospital.At the same time,fully combined with the results of drug susceptibility test,select antibiotics with high sensitivity and strengthen the monitoring of drug resistance of pathogens.2 The results showed that the retention time of the abdominal drainage tube was a risk factor for infection-related complications after hepatectomy for liver cancer.We should pay enough attention to this risk factor and strengthen the prevention of abdominal infection.3 The results of whole gene sequencing showed that the carbapenem-resistant strains were consistent with(1)producing type B carbapenemases;(2)Exist of Multiple efflux pump genes;(3)Carbapenem resistance mechanisms such as highly producing Amp C enzyme or ESBLs combined with outer membrane protein loss.Non carbapenem-resistant strains that lost the ELBLs or efflux pump gene may be the reason for their susceptibility to carbapenems.