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Neutropenia and Cancer Infections / Colorectal Cancer Surgical Treatments / Surgical Site Infection Prevention · Journal article
Frontiers in Public Health · August 5, 2026
Early or partial results. Treat as a signal, not a conclusion.
This prospective observational study of 211 patients undergoing elective gastrointestinal cancer surgery in a Romanian tertiary center found healthcare-associated infections in 15.6% (33/211), with a diverse microbiological profile including 44.4% of cultured isolates classified as multidrug- or extensively drug-resistant. Neoadjuvant radiotherapy was identified as an independent risk factor for infection in colorectal patients (adjusted OR 3.25, 95% CI 1.15–9.19, p = 0.026), but the finding requires confirmation in larger multicenter cohorts.
Prospective single-center observational study. Adult patients undergoing elective surgery for gastric or colorectal cancer at a Romanian tertiary referral center.. Intervention: Elective surgery for gastric or colorectal cancer (upper or lower gastrointestinal surgery). n = 211. Single Romanian tertiary referral center for oncological surgery.
Thirty-three of 211 patients (15.6%) developed at least one healthcare-associated infection, accounting for 39 episodes Neoadjuvant radiotherapy was an independent risk factor in colorectal patients (adjusted OR 3.25, 95% CI 1.15–9.19, p = 0.026) Of 27 culture-positive isolates, 44.4% were classified as multidrug- or extensively drug-resistant
Infection-attributable 30-day mortality was 1.9%
The identification of neoadjuvant radiotherapy as an independent risk factor for postoperative infection in colorectal cancer patients suggests a need for heightened surveillance and antimicrobial stewardship in this subgroup. The substantial antimicrobial resistance burden (44.4% of cultured organisms) underscores the importance of institution-specific surveillance data to inform local empiric therapy strategies.
Single-center prospective observational study with modest sample size describing incidence and risk factors for healthcare-associated infections; identifies neoadjuvant radiotherapy as an independent risk factor but lacks comparator arm and external validation.
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The identification of neoadjuvant radiotherapy as an independent risk factor for postoperative infection in colorectal cancer patients suggests a need for heightened surveillance and antimicrobial stewardship in this subgroup. The substantial antimicrobial resistance burden (44.4% of cultured organisms) underscores the importance of institution-specific surveillance data to inform local empiric therapy strategies.
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Background Healthcare-associated infections following gastrointestinal cancer surgery are typically reported in terms of surgical site infection alone, with limited data on the broader infectious spectrum, comparative microbiology between upper and lower gastrointestinal surgery, and antimicrobial resistance in Eastern European centers. We aimed to describe the incidence, types, risk factors, and microbiological profile of all healthcare-associated infections occurring within 30 days of surgery in a Romanian tertiary referral center for oncological surgery. Methods In a prospective single-center observational study, 211 consecutive adult patients undergoing elective surgery for gastric or colorectal cancer between May 2023 and July 2024 were followed for 30 days postoperatively. Healthcare-associated infections were defined according to Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance criteria, and multidrug- and extensively drug-resistant isolates were classified using consensus international definitions. Risk factors were assessed by univariate analysis and multivariable logistic regression with three pre-specified predictors: neoadjuvant radiotherapy, surgery duration, and male sex. Results Thirty-three patients (15.6%) developed at least one healthcare-associated infection, accounting for 39 episodes. The infection profile differed by surgical site: surgical site infection was the predominant infection type following lower gastrointestinal surgery (~46% of episodes), whereas device-associated and respiratory infections were relatively more common following upper gastrointestinal surgery (~38% of episodes together). Neoadjuvant radiotherapy-containing treatment was an independent risk factor in colorectal patients (adjusted odds ratio [OR] 3.25, 95% confidence interval [CI] 1.15–9.19, p = 0.026). Of 27 culture-positive isolates, 44.4% were classified as multidrug- or extensively drug-resistant, including a dual-carbapenemase-producing Klebsiella pneumoniae, a metallo- β -lactamase-producing Pseudomonas aeruginosa, and a single Candida auris isolate. Microbiological documentation was missing for 36.4% of infected patients, and infection-attributable 30-day mortality was 1.9%. Conclusion Postoperative healthcare-associated infection in gastrointestinal cancer surgery extends substantially beyond surgical site infection and carries a high antimicrobial resistance burden in this Romanian tertiary-center cohort. Neoadjuvant radiotherapy warrants heightened postoperative surveillance, though this independent association requires confirmation in larger multicenter studies. The substantial proportion of culture-negative or unsampled infections highlights a concrete quality-improvement target, while the documented resistance profile indicates that institution-specific surveillance data may complement broader national or European epidemiological information when developing local stewardship strategies.
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