Postoperative Bloodstream Infections in Patients with Peritoneal Surface Malignancies Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Risk Factors and Pathogen Resistance

Figures & data

Table 1 Basic Clinicopathologic Features of 1500 Patients with Peritoneal Surface Malignancies

Items	Value (%)
Gender
Male	572 (38.1)
Female	928 (61.9)
Age (years)
≤60	1027 (68.5)
>60	473 (31.5)
BMI (kg/m^2)
≤18.5	145 (9.7)
18.5–25.0	956 (63.7)
>25.0	399 (26.6)
Surgical history
Yes	989 (65.9)
No	511 (34.1)
Previous tumor treatment
Yes	921 (61.4)
No	579 (38.6)
Tumor tissue type
Peritoneal metastasis of gastric cancer	66 (4.4)
Peritoneal metastasis of small intestinal carcinoma	19 (1.3)
Peritoneal metastasis of colorectal cancer	278 (18.5)
Pseudomyxoma peritonei	475 (31.7)
Peritoneal metastasis of ovarian cancer plus primary Peritoneal Surface Malignancies	278 (18.5)
Malignant peritoneal mesothelioma	136 (9.1)
Retroperitoneal tumor	161 (10.7)
Other tumors	87 (5.8)

Table 2 Information of 1500 Patients with Peritoneal Surface Malignancies Undergoing CRS Combined with HIPEC

Items	Value
Surgical time (min), median (range)	585(90–1170)
PCI score, median (range)	20(1–39)
CC score, n (%)
0	710(47.3)
1	272(18.1)
2	200(13.3)
3	318(21.2)
Intraoperative blood loss (mL), median (range)	500(20–12,000)
Intraoperative erythrocyte transfusion (U), median (range)	2(0–28)
Intraoperative plasma transfusion (mL), median (range)	600(0–2200)
Intraoperative fluid infusion (mL), median (range)	6350(570–20,960)
Intraoperative urine volume (mL), median (range)	1700(150–8000)
Ascitic volume (mL), median (range)	200(0–22,000)
Stoma, n (%)
Yes	948(63.2)
No	552(36.8)
Number of organ resections, median (range)	2(0–10)
Number of peritoneal resections, median (range)	4(0–10)

Table 3 Distribution and Composition Ratio of Pathogens of Postoperative Hospital Infections

Pathogens	Strains	Composition Ratio (%)
Gram-negative bacilli	52	22.32
Klebsiella pneumoniae subsp. Pneumoniae	17	7.30
Escherichia coli	13	5.58
Acinetobacter baumannii	7	3.00
Enterobacter cloacae	7	3.00
Pseudomonas aeruginosa	5	2.15
Other	3	1.29
Gram-positive cocci	151	64.81
Coagulase-negative staphylococci	128	54.94
Enterococcus faecalis	11	4.72
Staphylococcus aureus	4	1.72
Enterococcus faecium	4	1.72
Other	4	1.72
Fungi	30	12.86
Candida albicans	13	5.58
Candida glabrata	7	3.00
Other	10	4.30

Table 4 Antimicrobial Drug Resistance Rate of Major Gram-Positive Cocci (%)

Antimicrobial Drugs	Coagulase-negative staphylococci (n=128)		Enterococcus faecalis (n=11)		Staphylococcus aureus (n=4)
	Strains	Resistance rate	Strains	Resistance rate	Strains	Resistance rate
Penicillin G	128	97.7	11	0	4	100
Gentamicin	128	21.9	11	9.1	4	75
Rifampicin	128	5.5	—	—	4	25
Ciprofloxacin	117	59.8	11	45.5	4	75
Levofloxacin	128	62.5	11	45.5	4	75
Tigecycline	115	0	10	0	3	0
Erythromycin	128	82	11	72.7	4	100
Linezolid	128	0	11	0	4	0
Vancomycin	128	0	11	0	4	0
Quinupristin/dalfopristin	117	0	—	—	4	0
Tetracycline	117	15.4	11	81.8	4	75

Table 5 Antimicrobial Drug Resistance Rate of Major Gram-Negative Bacilli (%)

Antimicrobial drugs	(n=17)		(n=13)		(n=7)
	Strains	Resistance rate	Strains	Resistance rate	Strains	Resistance rate
Ampicillin/sulbactam	17	70.6	12	75	7	57.1
Tazobactam/piperacillin	17	29.4	13	0	—	—
Ceftazidime	17	23.5	13	15.4	7	57.1
Ceftriaxone	17	41.2	13	53.8	7	57.1
Cefepime	17	17.6	13	23.1	7	57.1
Imipenem	17	23.5	13	7.7	7	57.1
Amikacin	17	17.6	13	0	—	—
Gentamicin	17	35.3	12	33.3	7	28.6
Tobramycin	17	23.5	12	8.3	7	28.6
Ciprofloxacin	17	35.3	12	91.7	7	57.1
Levofloxacin	17	35.3	13	92.3	7	28.6
Bactrim	16	43.8	13	61.5	7	0

Table 6 Antimicrobial Drug Resistance Rate of Major Fungi (%)

Antimicrobial Drugs	Candida albicans (n=13)		Candida glabrata (n=7)		Candida parapsilosis (n = 3)
	Strains	Resistance rate	Strains	Resistance rate	Strains	Resistance rate
Fluconazole	13	0	7	0	3	0
Voriconazole	13	0	7	0	3	0

Table 7 Analysis of Risk Factors Associated with Postoperative Bloodstream Infections in CRS Combined with HIPEC

Items	Bloodstream Infection Group	Non-Bloodstream Infection Group	P
Gender, n (%)			0.126
Male	69(33.3)	503(38.9)
Female	138(66.7)	790(61.1)
Age (years), n (%)			0.040
≤60	129(62.3)	898(69.5)
>60	78(37.7)	395(30.5)
BMI (kg/m^2), n (%)			0.947
≤18.5	21(10.1)	124(9.6)
18.5–25.0	130(62.8)	826(63.9)
>25.0	56(27.1)	343(26.5)
Surgical history, n (%)			0.033
Yes	150(72.5)	839(64.9)
No	57(27.5)	454(35.1)
Previous tumor treatment, n (%)			<0.001
Yes	153(73.9)	768(59.4)
No	54(26.1)	525(40.6)
Tumor tissue type, n (%)			0.034
Peritoneal metastasis of gastric cancer	5(2.4)	61(4.7)
Peritoneal metastasis of small intestinal carcinoma	1(0.5)	18(1.4)
Peritoneal metastasis of colorectal cancer	44(21.3)	234(18.1)
Pseudomyxoma peritonei	50(24.2)	425(32.9)
Peritoneal metastasis of ovarian cancer plus primary Peritoneal Surface Malignancies	46(22.2)	232(17.9)
Malignant peritoneal mesothelioma	20(9.7)	116(9.0)
Retroperitoneal tumor	22(10.6)	139(10.8)
Other tumors	19(9.2)	68(5.3)
Surgical time (min), median (range)	595(108–1070)	585(90–1170)	0.491
PCI score, median (range)	22(1–39)	20(1–39)	0.139
CC score, n (%)			0.004
0	83(40.1)	627(48.5)
1	38(18.4)	234(18.1)
2	23(11.1)	177(13.7)
3	63(30.4)	255(19.7)
Intraoperative blood loss (mL), median (range)	500(50–6000)	500(20–12,000)	0.883
Intraoperative erythrocyte transfusion (U), median (range)	2(0–20)	2(0–28)	0.429
Intraoperative plasma transfusion (mL), median (range)	600(0–1800)	600(0–2200)	0.991
Intraoperative fluid infusion (mL), median (range)	6560(2100 −14,780)	6300(570 −20,960)	0.075
Intraoperative urine volume (mL), median (range)	1500(300 −6400)	1700(150 −8000)	0.098
Ascitic volume (mL), median (range)			0.293
Stoma, n (%)			0.855
Yes	132(63.8)	816(63.1)
No	75(36.2)	477(36.9)
Number of organ resections, median (range)	2(0–9)	2(0–10)	0.524
Number of peritoneal resections, median (range)	5(0–10)	4(0–9)	0.890

Table 8 Logistic Regression Analysis of Risk Factors for Postoperative Bloodstream Infections in CRS Combined with HIPEC

Factors	Wald	OR	95% CI	P
Age (≤ 60 vs > 60)	6.231	0.666	0.484–0.916	0.013
Previous tumor treatment (No vs Yes)	10.134	0.565	0.397–0.803	0.001
Tumor tissue type	15.337			0.032
Peritoneal metastasis of gastric cancer vs other tumors	6.269	0.258	0.089–0.745	0.012
Peritoneal metastasis of small intestinal carcinoma vs other tumors	3.267	0.145	0.018–1.177	0.071
Peritoneal metastasis of colorectal cancer vs other tumors	1.568	0.672	0.360–1.252	0.211
Pseudomyxoma peritonei vs other tumors	8.169	0.406	0.219–0.753	0.004
Peritoneal metastasis of ovarian cancer plus primary PSM vs other tumors	1.790	0.652	0.349–1.220	0.181
Malignant peritoneal mesothelioma vs other tumors	2.072	0.589	0.286–1.211	0.150
Retroperitoneal tumor vs other tumors	1.002	0.696	0.343–1.415	0.317
CC score	15.101			0.002
0 vs.3	13.820	0.479	0.325–0.706	<0.001
1 vs 3	4.902	0.598	0.380–0.943	0.027
2 vs 3	0.952	0.729	–	0.329

Data Sharing Statement

The datasets used or analysed during the current study available from the corresponding author on reasonable request.