Skip to Main content Skip to Navigation
Master Thesis

Valeur prédictive des prélèvements bactériologiques per opératoires chez les patients opérés d’une chirurgie de cytoréduction associée à une chimiothérapie hyperthermique intra-péritonéale

Abstract : Background Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an emerging curative treatment option for patients with peritoneal carcinomatosis. It has a long-term survival benefit but is associated with high rates of morbidity, ranging from 12 % to 65 %, mainly due to infectious complications. We sought to evaluate the clinical relevance of routine intraoperative bacteriological sampling following CRS/HIPEC.
Study design Between November 2010 and December 2014, every patients receiving CRS/HIPEC were included. Three samples were routinely collected from standardized locations for intraperitoneal rinsing liquid bacteriological analysis (RLBA) after completion of HIPEC. The clinical and surgical features, bacteriological results, and short-term outcomes were retrospectively reviewed.
Results
The overall mortality and morbidity rates were 5 and 45 %, respectively. Among the 75 included patients, 40 % (n = 30) had at least one positive bacterial culture. Risk factors for a positive culture were colorectal resection (adjusted hazard ratio [HR] = 3.072, 95 % CI 1.843-8.004; p = 0.009) and blood loss >1000 mL (HR = 4.272, 95 % CI 1.080-18.141; p = 0.031). Among 26 (35 %) patients with abdominal infectious complications, 13 (17 %) experienced isolated complications. A positive RLBA result was independently associated with abdominal infectious complications (HR = 5.108, 95 % CI 1.220-16.336; p = 0.024) and isolated abdominal infectious complications (HR = 4.199, 95 % CI 1.064-15.961; p = 0.04).
Conclusions
Forty percent of the RLBA samples obtained following CRS/HIPEC tested positive for bacteria. Bacterial sampling of rinsing liquid should be systematically performed. An aggressive and immediate antibiotic strategy needs to be evaluated.
Document type :
Master Thesis
Complete list of metadatas

https://dumas.ccsd.cnrs.fr/dumas-01526475
Contributor : Bibliothèque Santé <>
Submitted on : Tuesday, May 23, 2017 - 10:52:02 AM
Last modification on : Monday, December 2, 2019 - 10:24:01 AM
Long-term archiving on: : Friday, August 25, 2017 - 12:51:18 AM

Identifiers

  • HAL Id : dumas-01526475, version 1

Citation

Marie Dazza. Valeur prédictive des prélèvements bactériologiques per opératoires chez les patients opérés d’une chirurgie de cytoréduction associée à une chimiothérapie hyperthermique intra-péritonéale . Médecine humaine et pathologie. 2017. ⟨dumas-01526475⟩

Share

Metrics

Record views

84

Files downloads

91