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Yujing L, Sijing L, Chengli N. Regarding "Symptomatic Lymphocele After Robot-Assisted Pelvic Lymphadenectomy as Part of the Primary Surgical Treatment for Cervical and Endometrial Cancer: A Retrospective Cohort Study". J Minim Invasive Gynecol 2024:S1553-4650(24)00239-5. [PMID: 38824997 DOI: 10.1016/j.jmig.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Li Yujing
- Center for Infectious Diseases, West China Hospital, Sichuan University, Chengdu, 610044, PR China
| | - Li Sijing
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400000, PR China
| | - Nie Chengli
- Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400000, PR China.
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Toyoshima H, Tanigawa M, Nakamura K, Ishiguro C, Tanaka H, Nakanishi Y, Sakabe S. First case of Cutibacterium avidum-infected pelvic lymphocele post-lymphadenectomy for endometrial cancer: A case report. Heliyon 2023; 9:e21396. [PMID: 37920529 PMCID: PMC10618815 DOI: 10.1016/j.heliyon.2023.e21396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
Background Pelvic lymphocele (lymphocyst) infection after lymphadenectomy is a rare complication that can cause the spread of inflammation to neighboring organs whose microbiology is not well known. Cutibacterium avidum causes various infections. However, no case reports of C. avidum pelvic lymphocele infection are available; therefore, its clinical characteristics in pelvic lymphocele infections remain unknown. Case presentation A 38-year-old woman with obesity (body mass index: 38.1 kg/m2) and a history of pelvic lymphadenectomy and chemotherapy for endometrial cancer presented with worsening left lower quadrant (LLQ) pain with fever. Physical examination revealed decreased abdominal bowel sounds and tenderness on LLQ palpation with no signs of peritonitis. Computed tomography (CT) revealed an infected left pelvic lymphocele with inflammation spreading to the adjacent sigmoid colon. Following blood culture, ampicillin/sulbactam (2 g/1 g every 6 h) was administered intravenously. Anaerobic culture bottles revealed gram-positive rods on day 4 of incubation at 37 °C. No other disseminated foci were observed in enhanced whole-body CT and upon transthoracic echocardiography. The isolates grew aerobically and anaerobically on blood agar plates with strong hemolysis. The bacterium was identified as C. avidum using a combination of characteristic peak analysis with matrix-assisted laser desorption ionization (MALDI) and 16S rRNA gene sequencing. The patient was diagnosed with C. avidum pelvic lymphocele infection. Based on penicillin susceptibility, the patient was successfully treated with intravenous ampicillin/sulbactam and de-escalated with intravenous ampicillin (2 g every 6 h) for 10 days, followed by oral amoxicillin (2000 mg/day) for an additional 11 days without drainage. Conclusions C. avidum should be considered a causative microorganism of pelvic lymphocele infection. Peak analysis using MALDI and distinctive growth on blood agar plates are suitable for identifying C. avidum. Mild pelvic lymphocele caused by C. avidum can be treated with a short course of appropriate antimicrobial treatment without surgical intervention.
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Affiliation(s)
- Hirokazu Toyoshima
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, 1-471-2, Funae, Ise, Mie, 516-8512, Japan
- Infection Prevention and Control Office, Japanese Red Cross Ise Hospital, Ise, 516-8512, Japan
| | - Motoaki Tanigawa
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, 1-471-2, Funae, Ise, Mie, 516-8512, Japan
| | - Kanako Nakamura
- Department of Medical Technology, Japanese Red Cross Ise Hospital, 1-471-2, Funae, Ise, Mie, 516-8512, Japan
| | - Chiaki Ishiguro
- Infection Prevention and Control Office, Japanese Red Cross Ise Hospital, Ise, 516-8512, Japan
- Department of Medical Technology, Japanese Red Cross Ise Hospital, 1-471-2, Funae, Ise, Mie, 516-8512, Japan
| | - Hiroyuki Tanaka
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, 1-471-2, Funae, Ise, Mie, 516-8512, Japan
| | - Yuki Nakanishi
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, 1-471-2, Funae, Ise, Mie, 516-8512, Japan
| | - Shigetoshi Sakabe
- Department of Infectious Diseases, Japanese Red Cross Ise Hospital, 1-471-2, Funae, Ise, Mie, 516-8512, Japan
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Robinson AV, Ali F, Dewar DJ, Peach AHS. Managing infected seroma post-lymphadenectomy; A retrospective cohort study and cost analysis in melanoma patients. J Plast Reconstr Aesthet Surg 2021; 74:2251-2257. [PMID: 33582049 DOI: 10.1016/j.bjps.2020.12.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/23/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Seromas are a common and unavoidable complication following lymphadenectomy, and often become clinically significant with superseded infection requiring re-admission for prompt intervention. However, there is no consensus as to whether a formal surgical incision and drainage (I&D), ultrasound (US)-guided aspiration or intravenous (IV) antibiotics alone is the most efficacious method of managing an infected seroma, the investigation of which formed the rationale for this study. SUBJECTS AND METHODS This retrospective cohort study included a consecutive series of patients readmitted for infected seroma following a lymphadenectomy for melanoma at Leeds Teaching Hospitals Trust (LTHT) from 2006 to 2017. Details on management, length of hospital stay, length of follow-up and number of clinical appointments required were examined. FINDINGS Seventy-one cases of infected seroma were identified from the cohort of 1691 lymphadenectomies. Initially, 21 patients (29.5%) were managed by IV antibiotics alone (failure rate of 52.4%); 18 (25.4%) with US-guided aspiration (failure rate 27.8%) and 32 (45.1%) with surgical I&D, which was 100% effective. Ultimately, 62.5% of the cohort required surgical management. Patients who underwent surgical I&D were discharged significantly faster following the procedure (3 versus 5 days for US-guided aspiration, p = 0.002) and spent fewer days in hospital overall (p = 0.022). The overall average cost was comparable across the three treatment groups. CONCLUSIONS Surgical management seemed preferential to conservative approaches in terms of efficacy and was not significantly more expensive overall; but carries anaesthetic risk. There may be a clinically significant difference in outcome depending on management; however, more evidence is required to investigate this.
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Affiliation(s)
- A V Robinson
- School of Medicine, University of Leeds, Leeds, United Kingdom.
| | - F Ali
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - D J Dewar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Leeds General Infirmary, Leeds, United Kingdom
| | - A H S Peach
- Department of Plastic, Reconstructive and Aesthetic Surgery, Leeds General Infirmary, Leeds, United Kingdom
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Comba C, Salik AE, Demirayak G, Erdogan SV, Sacan F, Ozdemir IA. Comparison of Postoperative Benign Pelvic Cysts Occurred after Gynecologic or Gyne-oncologic Surgery Treated with Percutaneous Transcatheteric Sclerosant Alcohol Therapy. Gynecol Minim Invasive Ther 2020; 9:198-203. [PMID: 33312862 PMCID: PMC7713659 DOI: 10.4103/gmit.gmit_107_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/16/2019] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives: Here, we compare the success of percutaneous transcatheter sclerosant alcohol therapy (PTSAT) for the postoperative treatment of benign pelvic cysts that occurred after gynecologic surgery. Materials and Methods: The study is a retrospective case–control trial. Gynecological patients who had symptoms due to postoperative pelvic cysts and received PTSAT after gynecologic surgery, between October 2008 and January 2018, were examined in a single training and research hospital in Turkey. Some factors were investigated for associations with postoperative pelvic cyst formation in patients who underwent gynecologic operations for malignancies or benign conditions. Statistical analysis used: The association between two independent and nonnormally distributed continuous variables was analyzed with the Mann–Whitney U-test. Spearman's rho correlation analysis was conducted to determine the correlation of two nonnormally distributed variables. Chi-square (or Fisher's exact test, when more suitable) was used to examine the correlation between categorical variables. Results: Statistically significant differences were found in terms of the average age was higher in patients with malignancies, and the average postoperative pelvic cyst detection time was higher in patients with benign pelvic cysts. While all patients were treated with PTSAT, repetitive PTSAT was required for seven benign and ten malign cases. Conclusion: Patients with pelvic cysts that occurred after gynecologic surgery for malignant conditions, large volume pelvic cysts and patients with benign cysts who underwent more than one surgery required recurrent PTSAT.
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Affiliation(s)
- Cihan Comba
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of Health Sciences, Sultangazi Haseki Training and Research Hospital, Istanbul, Turkey
| | - Aysun Erbahceci Salik
- Department of Interventional Radiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Demirayak
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Sakir Volkan Erdogan
- Department of Gynecology and Obstetrics, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Filiz Sacan
- Department of Interventional Radiology, Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Isa Aykut Ozdemir
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Medipol Mega University Hospital, Istanbul, Turkey
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Yamamoto S, Ikeda M, Kanno Y, Okamoto K, Okugawa S, Moriya K. Microbiological analysis of infectious lymphocele: Case series and literature review. J Infect Chemother 2020; 27:172-178. [PMID: 32900660 DOI: 10.1016/j.jiac.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/09/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Infectious lymphocele is a rare post-operative complication of abdominal surgery, and few studies have focused on its causative organisms. The aim in this research is to clarify microbiology and appropriate empiric treatment of infective lymphocele. METHODS We performed a single center, retrospective observational study between April 2000 and March 2018 with a case review and literature search. Data were collected in a chart review. RESULTS Twenty-four cases were founded in our institution. 153 cases, including 16 cases from our institution, that detected causative organisms was also analyzed. Infectious lymphocele was found to occur post gynecological/urological surgery in cancer patients. We also reported that bacteremia incidence and the mortality rate of infectious lymphocele cases were very low. The major sites of infectious lymphocele were pelvis or inguinal area. Our case series and literature review showed Gram positive cocci were the major causative organisms, with Staphylococcus aureus constituting one third of them (53/153 cases). Streptococcus species (26/153cases) and coagulase negative Staphylococci (17/153 cases) were the second and third most detected organisms. CONCLUSION In gynecologic and urologic cancer patients, Gram positive cocci were the most common organisms causing lymphocele infection. Gram-positive coverage might be reasonable for empiric therapy in infectious lymphocele.
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Affiliation(s)
- Shinya Yamamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Mahoko Ikeda
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan; Department of Infection Control and Prevention, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Yoshiaki Kanno
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shu Okugawa
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kyoji Moriya
- Department of Infectious Diseases, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan; Department of Infection Control and Prevention, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
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Antibiotic prophylaxis for gynecologic cancer surgery. Taiwan J Obstet Gynecol 2020; 59:514-519. [PMID: 32653122 DOI: 10.1016/j.tjog.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The use of prophylactic antibiotics in elective gynecologic cancer surgery is essential. We aimed to establish the optimal duration of antibiotic administration to reduce the overuse of antibiotics in gynecologic cancer surgery. MATERIALS AND METHODS We conducted a retrospective study based on the descriptive and statistical analysis of the clinical records of patients who underwent a radical hysterectomy or staging operation for gynecologic cancer between January 2014 and October 2015 at Busan Paik Hospital. Postoperative outcomes, such as surgical site infection (SSI), urinary tract infection (UTI), length of hospital stay, duration of urinary catheterization, and duration of surgical drainage, were compared between the antibiotic prophylaxis for 1-day and greater than 1-day groups. RESULTS A total of 139 patients were included in the study. There were 79 patients in the 1-day group (56.8%) and 60 patients in the >1-day (43.2%) group. The two groups were similar in terms of demographics, American Society of Anesthesiologists score, stage, surgical approach, and type of operation. Blood loss was smaller in the 1-day group than in the >1-day group (582.2 ± 278.3 cc vs. 795.9 ± 617.9 cc, P = 0.007). The average length of hospital stay was shorter in the 1-day group than in the >1-day group (10.8 ± 2.7 days vs. 11.8 ± 2.8 days, P = 0.039). The rate of SSI and UTI was not significantly different between the 1-day and >1-day groups (6.3% vs. 8.2% and 11.4% vs. 6.7%, respectively [P = 0.903 and P = 0.393]). CONCLUSION One-day first generation cephalosporin administration is appropriate for preventing post-surgical complications such as wound infections, UTIs, and vaginal cuff cellulitis in gynecologic cancer surgery.
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Profiling of the Causative Bacteria in Infected Lymphocysts after Lymphadenectomy for Gynecologic Cancer by Pyrosequencing the 16S Ribosomal RNA Gene Using Next-Generation Sequencing Technology. Infect Dis Obstet Gynecol 2019; 2019:9326285. [PMID: 30914831 PMCID: PMC6409011 DOI: 10.1155/2019/9326285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/04/2019] [Indexed: 11/26/2022] Open
Abstract
Background Surgery for gynecologic cancer with lymphadenectomy and pelvic radiotherapy can produce lymphoceles that sometimes complicate with infection, resulting in abscesses. The true pathogenic bacteria of abscesses are not always found because of false-negative results due to administered antibiotics and difficulty with detection, including for anaerobic bacteria. Analyzing bacteria flora by next-generation sequencing (NGS) using 16S ribosomal DNA may reveal the true pathogenic bacteria in abscesses. This is the first report on causative pathogens for infectious lymphocele using this technology. Methods The subjects were patients who developed infectious lymphocele after surgery for gynecologic cancer at our hospital from July 2015 to September 2016. NGS analyses of bacterial flora were performed using specimens preserved at -80°C. Two steps of PCR were performed for purified DNA samples to obtain sequence libraries. Processing of sequence data, including operational taxonomic unit (OTU) definition, taxonomy assignment, and an OTU BLAST search were performed. All patients gave written informed consent and the study was approved by the institutional research ethics committee. Results Six patients underwent puncture and drainage. The result in most cases indicated a single causative pathogen, including Staphylococcus lugdunensis, Streptococcus dysgalactiae, Streptococcus equinus, Enterococcus saccharolyticus, and Escherichia coli. Conclusions. NGS revealed that the causative bacteria in lymphocele infection are normally a single strain, such as a surface Gram-positive coccus or enteric bacteria. Antibiotics should be chosen as appropriate for elimination of these respective bacteria.
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Ma X, Wang Y, Fan A, Dong M, Zhao X, Zhang X, Xue F. Risk factors, microbiology and management of infected lymphocyst after lymphadenectomy for gynecologic malignancies. Arch Gynecol Obstet 2018; 298:1195-1203. [PMID: 30269216 PMCID: PMC6244691 DOI: 10.1007/s00404-018-4914-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/20/2018] [Indexed: 11/30/2022]
Abstract
Objective To evaluate risk factors, microbiology and management of infected lymphocysts in patients undergoing systemic lymphadenectomy for gynecological cancer. Methods Patients with gynecological cancer who developed postoperative lymphocysts after lymphadenectomy were enrolled between January 2009 and June 2017. The clinical data of infected lymphocysts were analyzed and compared with non-infected lymphocysts. Multivariate analysis of risk factors, the microbiology and therapeutic strategies for infected lymphocysts were also evaluated. Results A total of 115 patients out of 619 developed postoperative lymphocysts, the incidence of infected lymphocysts was 4.36%. Infected lymphocysts were more frequently found in patients with combined pelvic and para aortic lymphadenectomy, higher number of resected pelvic lymph nodes, lower level of postoperative serum hemoglobin and higher proportion of neutropenia. The median diameter of infected lymphocysts was significantly larger than non-infected (71.89 vs 38.47 mm, P < 0.001) and a large size (diameter over 60 mm) was identified as an independent risk factor for infected lymphocysts (OR = 3.933, P = 0.017). The microbiology of infected lymphocysts includes gram-positive cocci, gram-negative bacillus and anaerobic bacteria. Percutaneous catheter drainage was successfully performed in 20 patients with infected lymphocysts. 16 of 19 patients with large lymphoceles received combined antibiobics and PCD therapy and showed clinical remission in all cases. Patients with large size infected lymphocysts who received combined therapy experienced a significantly shorter treatment period and lower recurrent rate than those with only antibiotics (P = 0.046, P = 0.018). Conclusions The current study demonstrated that a diameter over 60 mm was an independent risk factor for infected lymphocysts. The predominant bacteria originated from the urogenital or skin flora. The combination of PCD with appropriate antibiotics was a convenient and effective therapeutic strategy resulting in a high success rate.
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Affiliation(s)
- Xuegong Ma
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Yingmei Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Aiping Fan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Mengting Dong
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Xin Zhao
- Department of Radiology, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Xuhong Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, 154# AnShan Road, Heping District, Tianjin, 300052, People's Republic of China.
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Nomogram predicting risk of lymphocele in gynecologic cancer patients undergoing pelvic lymph node dissection. Obstet Gynecol Sci 2017; 60:440-448. [PMID: 28989920 PMCID: PMC5621073 DOI: 10.5468/ogs.2017.60.5.440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/03/2017] [Accepted: 06/12/2017] [Indexed: 11/22/2022] Open
Abstract
Objective The purpose of this study is to estimate the risk of postoperative lymphocele development after lymphadenectomy in gynecologic cancer patients through establishing a nomogram. Methods We retrospectively reviewed 371 consecutive gynecologic cancer patients undergoing lymphadenectomy between 2009 and 2014. Association of the development of postoperative lymphocele with clinical characteristics was evaluated in univariate and multivariate regression analyses. Nomograms were built based on the data of multivariate analysis using R-software. Results Mean age at the operation was 50.8±11.1 years. Postoperative lymphocele was found in 70 (18.9%) patients. Of them, 22 (31.4%) had complicated one. Multivariate analysis revealed that hypertension (hazard ratio [HR], 3.0; 95% confidence interval [CI], 1.5 to 6.0; P=0.003), open surgery (HR, 3.2; 95% CI, 1.4 to 7.1; P=0.004), retrieved lymph nodes (LNs) >21 (HR, 1.8; 95% CI, 1.0 to 3.3; P=0.042), and no use of intermittent pneumatic compression (HR, 2.7; 95% CI, 1.0 to 7.2; P=0.047) were independent risk factors for the development of postoperative lymphocele. The nomogram appeared to be accurate and predicted the lymphocele development better than chance (concordance index, 0.754). For complicated lymphoceles, most variables which have shown significant association with general lymphocele lost the statistical significance, except hypertension (P=0.011) and mean number of retrieved LNs (29.5 vs. 21.1; P=0.001). A nomogram for complicated lymphocele showed similar predictive accuracy (concordance index, 0.727). Conclusion We developed a nomogram to predict the risk of lymphocele in gynecologic cancer patients on the basis of readily obtained clinical variables. External validation of this nomogram in different group of patients is needed.
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Evaluation of sclerotherapy for the treatment of infected postoperative lymphocele. Taiwan J Obstet Gynecol 2017; 56:477-481. [DOI: 10.1016/j.tjog.2016.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/20/2022] Open
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Hamada A, Hwang C, Fleisher J, Tuerk I. Microbiological evaluation of infected pelvic lymphocele after robotic prostatectomy: potential predictors for culture positivity and selection of the best empirical antimicrobial therapy. Int Urol Nephrol 2017; 49:1183-1191. [PMID: 28439680 DOI: 10.1007/s11255-017-1599-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/16/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To examine symptomatology and microbiology of infected lymphocele (LC) post-robotic-assisted radical prostatectomy and pelvic lymph node dissection (PLND) and to assess for potential predictors for LC fluid culture positivity. Secondly, to provide general recommendations about use of select antimicrobial therapy. METHODS This was a single-center, IRB-approved, retrospective, case series review conducted between October 2008 and October 2014. Data included symptomatology, microbiology of symptomatic LC in men post-robotic prostatectomy and PLND. Those with infected LC were compared to those men with symptomatic LC in the absence of infection. RESULTS Symptomatic LC was seen in 7% of men, and among those, infected LC was seen in 42%. Infected LC cultures showed predominance of G+ cocci such as S. aureus, coagulase-negative Staphylococcus species, S. pyogenes, S. fecalis and S. viridans. Monomicrobial infection was seen in 85%. Multivariate logistic regression showed leukocytosis [Odds: 12.3, p = 0.03, 95% CI (1.2-125)] was significant predictor for culture positivity, whereas trend toward significance for factors such CT findings of thickened walls around the LC +/- air. CONCLUSIONS LC infection following PLND for prostate cancer is usually monomicrobial and caused by Gram+ cocci. GI tract and skin flora are the main habitat. High index of suspicion of infected LC is undertaken in the presence of leukocytosis, fever and abnormal CT findings. Based upon our local hospital antibiogram, combination of IV ampicillin/sulbactam and vancomycin is suggested as the best initial empiric therapy in treating these patients.
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Affiliation(s)
- Alaa Hamada
- Division of Urology, Department of Surgery, St. Elizabeth's Medical Center, Steward Health System, TUFTS University School of Medicine, 11 Nevins Street, MOB, Suite 303, Boston, MA, 02135, USA.
| | | | - Jorge Fleisher
- Division of Infectious Disease, Department of Medicine, St. Elizabeth's Medical Center, Steward Health System, TUFTS University School of Medicine, Boston, MA, 02135, USA
| | - Ingolf Tuerk
- Division of Urology, Department of Surgery, St. Elizabeth's Medical Center, Steward Health System, TUFTS University School of Medicine, 11 Nevins Street, MOB, Suite 303, Boston, MA, 02135, USA
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