Nosocomial Infection in A Single Center of Department of Interventional Vascular Surgery- A Retrospective Analysis Of 10 Years

Results: There were 10,192 inpatients in DIVS in 10 years. Nosocomial infections occurred in 341 cases. The percent of patients with nosocomial infection of the total inpatients was 3.1%. The incidence of nosocomial infection was the lowest in PLC patients treated with TACE than the patients diagnosed liver metastasis and other vascular and biliary system-related diseases (166/7862 vs 83 / 1021 vs 72/1000 patients (p<0.01)). The top three sites with the high infection rate were the peritoneum and digestive system, respiratory system, and blood system (48.7%, 28.7%, and 14.1%, respectively). The median of hospital stay was 17 days for patients with nosocomial infections, the median time was 8 days from admission to occurrence of nosocomial infection, and the time of nosocomial infection occurred about 4 days post-surgery. Forty-three of 88 cases had positive pathogens.


Introduction
China had about 50% primary liver cancer (PLC, mainly hepatocellular carcinoma (HCC)) of the world [1]. Transcatheter arterial chemoembolization (TACE) is the most common treatment for primary liver cancer (PLC) in China [2]. However, PLC is prone to nosocomial infection. Once infection occurs, it will limit the interventional treatment and affect the prognosis of patients [3]. But [4]. In brief, nosocomial infection is diagnosed by positive laboratory results of pathogen and a compatible clinical syndrome occurring 72 hours or longer after admission, or less than 72 hours after admission if patients had been admitted to the hospital before and discharged within the previous one month. The outcomes of deaths attributable to nosocomial infection were judged by a physician. TACE was carried out as the report [5]. Other invasive procedures were performed according to the normal operation guidelines. On the day postsurgery, patients were given glucose and saline, cephalosporin second-generation antibiotics to prevent infection, and protection treatment for liver function. This study was approved by the ethics committee of the hospital. Informed consent of patients was obtained prior to treatment.

Methods
A retrospective analysis method was used to review all medical records and diagnoses, general conditions and laboratory test results, nosocomial infection time, infected sites, pathogenic microorganisms, and prophylactic antibiotic use. Liver function was measured using an ALL-640 OLYMPUS automatic biochemical analyzer, blood routine examination was measured using a System XE-5000 automatic hematology analyzer, and serum hepatitis markers were detected by chemiluminescence. Pathogen culture was performed by the BD BACTECTM 9120/9240 automatic culture system (BD Biomedical Co., Ltd. Instrument Shanghai Co., Ltd.). Pathogens and drug susceptibility analysis were performed by Siemens Microscan Walkaway 96 automatic microbial analyzer.

Statistical Analysis
Data were analyzed using SPSS16.0 statistical software, and correlation analysis was performed using Spearman analysis.

Nosocomial Infection and Pathogen
Eighty  in patients undergoing primary liver cancer resection was 10.15% [8]. A small sample of liver cancer with local surgery (radiofrequency ablation) showed a nosocomial infection percent of 2.56% (2/78) [9]. Nosocomial infection is one of the main reasons for PLC death [3]. We searched the literatures that the prevalence of nosocomial that nosocomial infection percentages in PLC patients undergoing surgery, especially those who had local surgery, were lower than those without surgery [3,[6][7][8][9]. The reason may be related to the need for better liver function in patients receiving surgery such as TACE, that is, mostly patients at Child-Pugh A or B stage.
In this study, inpatients with nosocomial infection were mostly PLC, and the sites of nosocomial infection were mostly peritoneum and digestive system, followed by respiratory system, blood system However, the duration between the admission and surgical time was generally short, and postoperative nosocomial infections occurred in a few days. Therefore, outpatients should strengthen the immunity and improve the healthy before admission. Escherichia coli were ranked at the first or second in nosocomial infections and have multi-drug resistance. The occurrence of nosocomial infection induced by production of extended-spectrum β-lactamases (ESBLs) strains has increased, of which Escherichia coli and Klebsiella pneumonia (KP) induce multidrug-resistance [13]. In our hospital, more than 50% cases of KP were resistant to ofloxacin. The data was like Taiwan that 124 (52.8%) cases of ESBL-producing KP were resistant to ciprofloxacin [14]. The present study was showed Escherichia coli in blood and bile juice, as well as the report by Jiang Yongjun et al. [8]. The detection rates of Staphylococcus aureus, Klebsiella pneumoniae, and Acinetobacter baumannii with the increased drug resistance have also increased year by year [15].
Cephalosporins II has used usually for prevention of nosocomial infections. But above bacteria are not sensitive to the antibiotics. Therefore, to investigate pathogens is very important prior to antibiotics administration.
In all, the treasures to reduce nosocomial infection include strictly select appropriate patients for TACE, strictly perform aseptic operations and disinfection and isolation measures, strengthen pipeline care, and monitor biochemical and blood regularly, treat underlying primary diseases.