Purpose: To survey postoperative infections (PIs) after digestive surgery. Methods: This survey, conducted by the Japan Society for Surgical Infection, included patients undergoing digestive surgery at 28 centers between September 2015 and March 2016．Data collected included patient background characteristics, type of surgery, contamination status, and type of PI, including surgical site infection (SSI), remote infection (RI), and antimicrobial-resistant (AMR) bacterial infections and colonization. Results: PIs occurred in 10.7% of 6,582 patients who underwent digestive surgery (6.8% for endoscopic surgery and 18.7% for open surgery). SSIs and RIs, including respiratory tract infection, urinary tract infection, antibiotic-associated diarrhea, drain infection, and catheter-related bloodstream infection, occurred in 8.9% and 3.7% of patients, respectively. Among all PIs, the most common overlapping infections were incisional and organ/space SSIs, which occurred in 4.2% of patients. AMR bacterial infections occurred in 1.2% of patients after digestive surgery. The rate of AMR bacterial colonization after digestive surgery was only 0.3%. Conclusions: Periodic surveillance of PIs, including AMR bacteria, is necessary for a detailed evaluation of nosocomial infections.

The Japan Society for Surgical Infection took the lead JPICS ’15 (Japanese Postoperative Infectious Complications Surveillance 2015) and Studies on postoperative remote infection on length of stay and medical costs in hospitals,and published three and two papers each. There were studied not only surgical site infections but remote infections that were includes postoperative respiratory tract infection, urinary tarct infections, bacteremia, cathter related infection and postoperative Antibiotic-associated colitis (AAC: MRSA enterocolitis and CDI: Clostridioides difficile infection).

Purpose: To survey postoperative infectious complications after digestive surgery. Methods: This survey by the Japan Society of Surgical Infection included patients undergoing digestive surgery at the 28 centers between September 2015 and February 2016．Data collected included patient background characteristics, type of surgery, contamination status, type of postoperative infection including surgical site infection (SSI), remote infection (RI), and antimicrobial-resistant (AMR) bacterial infections as well as AMR bacterial colonization. Results: Postoperative infections, which occurred in 10.7% of 6,582 patients who underwent digestive surgery and included in the survey, were significantly less frequent with endoscopic surgery than with open surgery (6.8% vs. 18.7%, P ＜ 0.01). Additionally, postoperative Antibiotic-associated colitis (AAC: MRSA enterocolitis and CDI: Clostridioides difficile infection) occurred 51 cases (0.7%). Among them, MRSA enterocolitis was occurred two cases (0.03%) and CDI occurred 36 cases (0.5%). Conclusions: Periodic surveillance of postoperative infections including remote infections surveillance is mandatory for a detailed elucidation of nosocomial infections.

Postoperative pneumonia is treated as one of the postoperative pulmonary complications. The development of postoperative pneumonia affects the prognosis. In the field of gastrointestinal surgery, esophageal cancer surgery, liver transplant surgery, and stomach cancer were common. Preoperative chronic obstructive pulmonary disorder and the elderly are important risk factors for postoperative pneumonia, with other factors such as sarcopenia and obesity. In terms of surgical methods, the incidence of postoperative pneumonia is lower in microscopy. There is also an attempt to predict the onset of a risk index by creating a risk index that combines many risk factors. It is thought that taking measures against one risk factor will not be effective. It is important to set up a multidisciplinary task force and create bundles for various risk factors to prevent their onset. At the time of onset, it is necessary to try to detect it at an early stage. The causative bacteria of postoperative pneumonia are Pseudomonas aeruginosa and MRSA. If possible, it is considered more effective to select therapeutic antibacterial drugs using anti-biograms created at each facility by gram staining. And we should be careful not to induce drug-resistant bacteria.

Postoperative remote infection (RI) in gastrointestinal cancer surgery prolongs postoperative hospital stay, decreases QOL, and increases medical costs. As the number of elderly patients has been increasing, the importance of prevention and management for RI has been gaining. The incidence and risk factors of RI in gastric cancer surgery were reviewed; from 2013 to 2017, 610 patients who underwent gastrectomy for gastric cancer in our institution were included. RI was observed in 40 patients (6.6%), including pneumonia in 27 patients (4.4%), urinary tract infection in 11 (1.8%), and non-surgical cellulitis in 2 (0.3%). We analyzed risk factors by comparing 40 patients in the RI group and 570 patients in the non-RI group. In univariate analysis, age, ASA, PS, PNI, and modified GPS were factors that influenced the occurrence of RI. Multivariate analysis identified a PNI＜51 as a risk factor. Preoperative nutritional intervention is necessary for malnourished patients to prevent the development of RI.

We report a rare case of ruptured pseudoaneurysm successfully treated by muscle flap and continuous irrigation and negative pressure wound therapy with instillation and dwelling. A 82-year old male had s painful mass in the middle of left thigh. CT findings demonstrated a ruptured pseudoaneurysm at the proximal anastomosis following the below-knee femoro-popliteal bypass. We performed emergency endovascular repair to save his limb. After that, we had to perform two operations due to large hematomas and skin necrosis of the left thigh. In the initial operation, we performed resection and debridement of the aneurysm and surrounding tissues including hematomas, followed by the rectus abdominal muscle flap. Despite of the removal of hematoma and muscle flap coverage, the hematoma had recurred. In the second operation, we performed drainage of the hematoma and continuous irrigation for one weeks. The patient finally achieved good granulation tissue formation with negative pressure wound therapy with instillation and dwelling. Twelve months after surgery, no recurrence of the pseudoaneurysm.