55 Infectious morbidity after surgery in advanced ovarian cancer: challenges with antimicrobial resistance in a tertiary cancer center in eastern india

Abstract

Objectives To assess the incidence of postoperative infectious morbidity (POIM) after cytoreductive surgery (CRS) in advanced ovarian cancer (AOC) patients and utilization of pre-operative stool surveillance culture in prediction of antimicrobial resistance (AMR) and treatment of POIM. Methods Retrospective observational study in FIGO stage III/IV AOC patients operated between 2015 to 2018 at Tata Medical Center, Kolkata, India. Data was extracted from hospital electronical medical records. Results Out of 328 patients operated, pre-operative stool culture report was available in 225 women. Multidrug resistant organisms (MDRO) was isolated in 177 (78.6%); E Coli (n=136), Klebsiella (n=48), Enterobacter (n=40), Psedomonas (n=2), Acinetobactor (n=1). E.Coli was the major organism isolated in blood stream, urine and body fluid in patients with POIM (60%). Clinical/Microbial confirmed POIM was diagnosed in 107/225 (47.5%) women up to 30 days post-opera-tively; Clavien-Dindo(CD)2 in 88, CD3 in 12, CD4 in 5 and CD5 in 2 women. AMR pattern in MDRO: Amoxiclavulanate (90%), Piperacillin-Tazobactam(50-60%), Meropenem (30-40%) and Colisitn and Fosfomycin (0-5%) making Merope-nem the most commonly prescribed antibiotic for POIM. In multivariate analysis, Diabetes Mellitus (OR 3.0,CI 1.3-7.0) and Bowel resection (OR4.4, CI 2.2-9.8) were independent risk factors for POIM(p<0.05), while splenectomy and diaphragmatic surgery was significantly associated in univariate analysis. Conclusions CRS in AOC was associated with high incidence of POIM at our setting; pre-operative surveillance stool culture could guide us in starting the appropriate antibiotic post-operatively at the earliest clinical suspicion based on the MDRO profile. Although, the treatment cost is high, > 80% women go home around the 7th post-operative day.