Postoperative infections in cytoreductive surgery with hyperthermic intraperitoneal intraoperative chemotherapy for peritoneal carcinomatosis.

BACKGROUND: Peritoneal carcinomatosis is a common evolution of many abdominal and pelvic malignancies. Over the last decade novel therapeutic approaches have emerged combining cytoreductive surgery with perioperative intraperitoneal chemotherapy. Aim of our study was to assess frequency, sites, and organisms of postoperative infections in this surgery and to evaluate associated risk factors and clinical outcome. METHODS: Retrospective study of postoperative infection in 30 patients undergoing combined cytoreductive surgery and hypertermic intraoperative chemotherapy in an oncologic surgery in Rome, between June 2001 and December 2004. RESULTS: Twenty-nine postoperative infections were recorded in 11 patients (36.7%; 2.6 infections per patient), including 13 surgical site infections, 8 clinical sepsis, 6 bloodstream infections, and 2 pneumonias. At multivariate analysis, total peritonectomy was found as independent variable associated to postoperative infection. Mortality rates were 36.4% and 5% among patients with and without postoperative infections, respectively (P = 0.04). Four of the 5 patients with invasive candidosis died. CONCLUSIONS: Peritonectomy procedures have an high risk of postoperative infections, prolonged hospital stay, and high morbidity and mortality. The increasing role of this surgery for the treatment of peritoneal carcinomatosis should strengthen the need for a careful evaluation of possible risk factors for postoperative infections, including the role of colonizing organisms.

Hospital infection control in Italy.

In 1998, the National Health Plan identified the reduction of hospital infection (HI) incidence as a priority. This article reviews the main activities set up in Italy on infection control in the hospital setting. In 1983, the first national prevalence survey reported 6.8% and 7.6% prevalence rates of patients with HI and of HIs, respectively. The high point prevalence found in the intensive care units (ICU) (12.5%), prompted a national incidence study in 1985. This study found an incidence of 29.5 HIs per 100 patients in the ICUs: lower respiratory tract infections (LRTI) were the most common HIs (47.8%), followed by urinary tract infections (UTI) (19.9%) and blood stream infections (BSI) (4.8%). A 1999 survey showed that in 463 Italian hospitals only 40.5% had protocols on the use of disinfectants, 32.3% on sterilization, 30.8% on occupational risk management, 18.3% on isolation measures, 17.7% on hand-washing, 14.3% on antibiotic prophylaxis in surgery, 9.4% on the prevention of surgical site infections and 8.5% on the management of CVC. A national forum to consider surveillance systems using standardized definitions and methodologies is urgently needed.