1.The importance for early operation in severe acute pancreatitis treatment
Shichen LUO ; Ruixiang HU ; Shiyan ZHANG
Journal of Clinical Surgery 1999;0(05):-
Objective To investigate the importance for early operation in severe acute pancreatitis (SAP) treatment. Method We retrospectively compared the mortality of 37 cases of SAP gradeⅡthat were treated by non-operative and early operative methods.Result The mortality of the nonoperative group was significantly higher than operative group (88.9% to 42.1%). Conclusion In the early course of SAP, nonoperative treatment should not overemphasized and,operation should be considered as a therapeutic method according to different pathophysiological changes.
2.A multicenter clinical study of 280 cases of staphylococcal peritoneal dialysis-associated peritonitis
Xinyang LI ; Liming YANG ; Xueyan ZHU ; Xiaoxuan ZHANG ; Jing ZHAO ; Shichen LIU ; Xiaohua ZHUANG ; Yanfeng WU ; Ping LUO ; Wenpeng CUI
Chinese Journal of Nephrology 2021;37(4):321-326
Objective:To investigate the incidence, drug sensitivity and drug resistance characteristies, and theraputic effect of staphylococcal peritoneal dialysis-associated peritonitis (PDAP), aim to provide clinical evidences for standardizing treatment therapy of staphylococcal PDAP. Methods:Clinical data of PDAP patients admitted to the Second Hospital of Jilin University, the First Hospital of Jilin University-the Eastern Division, Jilin Central Hospital and Jilin First Automobile Work General Hospital during January 1, 2013 and December 31, 2019 were retrospectively collected. The results of etiology, drug sensitivity and drug resistance of staphylococcal PDAP patients were collected. According to the pathogenic bacteria, patients were divided into staphylococcus aureus group ( n=48) and coagulase-negative staphylococcus group ( n=232). According to the results of methicillin resistance, patients were divided into drug-resistant group ( n=71) and drug-sensitive group ( n=30). The prognosis of antibiotic therapy in each group were compared. Poisson regression was used to test the changing trend of the incidence of staphylococcal PDAP. The changes of drug sensitivity and drug resistance of staphylococcus were compared between 2013 and 2019 by linear trend χ2 test. Results:A total of 1 085 cases of PDAP occurred in 625 patients were screened, and 280 cases of staphylococcal PDAP were finally included. The incidences of staphylococcal PDAP, staphylococcus aureus PDAP and coagulase-negative staphylococcal PDAP were 0.063 times per patient year, 0.010 times per patient year and 0.053 times per patient year respectively. In addition, the incidence of PDAP caused by staphylococcus, staphylococcus aureus and coagulase-negative staphylococcus decreased year by year (all P<0.05). With the change of years, the sensitivity rate of staphylococcus to rifampicin increased, while the sensitivity rate of staphylococcus to moxifloxacin decreased (both P<0.05). The drug resistance rate of staphylococcus to levofloxacin increased ( P<0.05). The staphylococcus aureus group was more prone to refractory PDAP and catheter removal than that in coagulase-negative staphylococcus group, and the recurrence rate was higher than that in coagulase-negative staphylococcus group (all P<0.05). The proportion of vancomycin used during the whole course of antibiotic therapy in drug-resistant group was higher than that in drug-sensitive group ( P<0.05). Conclusions:The incidence of staphylococcal PDAP decreases year by year, and the drug sensitivity characteristics of staphylococcus also change. The therapeutic outcomes of staphylococcus aureus PDAP are worse than that of coagulase-negative staphylococcus.
3.Clinical characteristics and treatment outcomes of first peritonitis in patients receiving long-term peritoneal dialysis: a multicenter study.
Jing ZHAO ; Liming YANG ; Xueyan ZHU ; Xiaoxuan ZHANG ; Xinyang LI ; Shichen LIU ; Xiaohua ZHUANG ; Wenhua ZHOU ; Ping LUO ; Wenpeng CUI
Journal of Southern Medical University 2020;40(12):1740-1746
OBJECTIVE:
To analyze the clinical characteristics and treatment outcomes of the first episode of peritoneal dialysis-associated peritonitis (PDAP) in patients receiving long-term peritoneal dialysis.
METHODS:
The clinical data of patients with the first episode of PDAP in 4 general hospitals in Jilin Province from 2013 to 2019 were collected retrospectively. According to the duration of dialysis, the patients were divided into long-term (≥36 months) and short-term (< 36 months) dialysis groups for comparison of the clinical data, treatment outcomes and long-term prognostic events.
RESULTS:
A total of 625 patients with PDAP were enrolled, including 93 on long-term and 532 on short-term dialysis. Compared with those on short-term dialysis, the patients on long-term dialysis had significantly higher hemoglobin levels and lower glomerular filtration rates when the first episode of PDAP occurred (
CONCLUSIONS
Compared with those on short-term dialysis, patients on long-term dialysis are prone to gram-negative bacterial infection when the first episode of PDAP occurs with worse treatment outcomes but similar long-term outcomes. Long-term dialysis is an independent risk factor of extubation and treatment failure for the first episode of PDAP, and fungal and mixed bacterial infections are independent risk factors for treatment failure of the first PDAP in patients with long-term dialysis.
Humans
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Kidney Failure, Chronic/therapy*
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Peritoneal Dialysis/adverse effects*
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Peritonitis/etiology*
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Retrospective Studies
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Treatment Outcome
4.Surgical site infection following abdominal surgery in China: a multicenter cross-sectional study.
Zhiwei WANG ; Jun CHEN ; Jianan REN ; Peige WANG ; Zhigang JIE ; Weidong JIN ; Jiankun HU ; Yong LI ; Jianwen ZHANG ; Shuhua LI ; Jiancheng TU ; Haiyang ZHANG ; Hongbin LIU ; Liang SHANG ; Jie ZHAO ; Suming LUO ; Hongliang YAO ; Baoqing JIA ; Lin CHEN ; Zeqiang REN ; Guangyi LI ; Hao ZHANG ; Zhiming WU ; Daorong WANG ; Yongshun GAO ; Weihua FU ; Hua YANG ; Wenbiao XIE ; Erlei ZHANG ; Yong PENG ; Shichen WANG ; Jie CHEN ; Junqiang ZHANG ; Tao ZHENG ; Gefei WANG
Chinese Journal of Gastrointestinal Surgery 2018;21(12):1366-1373
OBJECTIVE:
To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China.
METHODS:
The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI.
RESULTS:
A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI.
CONCLUSIONS
The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.
Abdomen
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surgery
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Adult
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Aged
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China
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Cross-Sectional Studies
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Female
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General Surgery
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statistics & numerical data
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Humans
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Male
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Middle Aged
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Operative Time
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Postoperative Complications
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prevention & control
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Preoperative Period
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Retrospective Studies
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Risk Factors
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Surgical Wound Infection
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prevention & control
5. Investigation of treatment and analysis of prognostic risk on enterocutaneous fistula in China: a multicenter prospective study
Tao ZHENG ; Haohao XIE ; Xiuwen WU ; Qiang CHI ; Feng WANG ; Zhenhua YANG ; Chaowu CHEN ; Wei MAI ; Suming LUO ; Xiaofei SONG ; Shimin YANG ; Wei ZHOU ; Haiyan LIU ; Xinjian XU ; Zheng ZHOU ; Chuanyuan LIU ; Lian′an DING ; Kai XIE ; Gang HAN ; Hongbin LIU ; Jianzhong WANG ; Shichen WANG ; Peige WANG ; Gefei WANG ; Guosheng GU ; Jian′an REN
Chinese Journal of Gastrointestinal Surgery 2019;22(11):1041-1050
Objective:
To investigate the diagnosis and treatment for enterocutaneous fistula (ECF) in China, and to explore the prognostic factors of ECF.
Methods:
A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of ECF patients from 54 medical centers in 22 provinces/municipalities from January 1, 2018 to December 31, 2018. The clinical data included patient gender, age, length of hospital stay, intensive care unit (ICU) admission, underlying diseases, primary diseases, direct causes of ECF, location and type of ECF, complications, treatment and outcomes. All medical records were carefully filled in by the attending physicians, and then re-examined by more than two specialists. The diagnosis of ECF was based on the clinical manifestations, laboratory/imaging findings and intraoperative exploration.
Results:
A total of 1521 patients with ECF were enrolled, including 1099 males and 422 females, with a median age of 55 years. The top three primary diseases of ECF were malignant tumors in 626 cases (41.2%, including 540 gastrointestinal tumors, accounting for 86.3% of malignant tumors), gastrointestinal ulcers and perforations in 202 cases (13.3%), and trauma in 157 cases (10.3%). The direct causes of ECF were mainly surgical operation in 1194 cases (78.5%), followed by trauma in 156 (10.3%), spontaneous fistula due to Crohn