Characterization and impact of wound infection after pancreas transplantation
J. E. Everett, D. C. Wahoff, C. Statz, K. J. Gillingham, A. Gruessner, R. W. Gruessner, P. F. Gores, D. E. Sutherland and D. L. Dunn
Division of Surgical Infectious Disease, University of Minnesota, Minneapolis.
OBJECTIVE: To characterize the incidence, microbial pathogenesis, risk
factors, and impact of wound infection after pancreas transplantation.
DESIGN: Retrospective analysis. SETTING: A large university hospital.
PATIENTS: From January 1, 1990, to September 30, 1993, 197 patients
underwent 207 consecutive pancreas transplantation procedures. MAIN OUTCOME
MEASURES: Wound infection and patient and allograft survival rates at 1
year. RESULTS: Sixty-nine patients (33%) suffered wound infections: 21
(10%) were superficial; 31 (15%), deep; and 17 (8%), combined. Most (74%)
wound infections were monomicrobial. Staphylococcus epidermidis and Candida
species were the most common pathogens. Prolonged operating time, older
donors, and enteric drainage were associated with higher wound infection
rates. Deep and combined wound infections led to allograft loss despite
subsequent salvage procedures. Combined wound infection was associated with
significantly higher mortality. CONCLUSIONS: A deep wound infection should
be an indication for allograft removal. Antifungal prophylaxis, stringent
donor criteria, and delayed primary wound closure should lower the
incidence of wound infection.
