A meta-analysis and systematic review of intraoperative bile cultures association with postoperative complications in pancreaticoduodenectomy

Filson, Anthony; Gaskins, Jeremy; Martin, Robert C.G.

doi:10.1016/j.surg.2022.12.012

Cited by 6 publications

(8 citation statements)

References 25 publications

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“…In the case of pancreaticoduodenectomies, similar findings to those of this research have been observed in observational studies [ 32 – 34 ], systematic reviews, and meta-analyses [ 34 , 35 ].…”

Section: Discussionsupporting

confidence: 88%

“…The systematic reviews and meta-analysis indicated an association between a positive intraoperative bile culture and the likelihood of a patient developing a surgical site infection [ 9 , 35 ]. Müssle et al identified bacterobilia in nearly half of pancreaticoduodenectomies, and this was linked to a higher incidence of surgical site infections.…”

Section: Discussionmentioning

confidence: 99%

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Relationship between Intraoperative Bile Culture Outcomes and Subsequent Postoperative Infectious Complications: A Retrospective Cohort Study

Ramírez-Arbeláez,

Arroyave-Zuluaga,

Barrera-Lozano

et al. 2024

BioMed Research International

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The presence of positive bile culture during intraoperative procedures has been associated with elevated morbidity and mortality rates in hepatobiliopancreatic surgeries, contributing to increased healthcare expenditures. However, the precise impact of bactobilia on the development of postoperative complications remains uncertain due to existing disparities in the published literature. In this retrospective cohort study, we assessed 137 patients who underwent major hepatobiliopancreatic surgery to examine the relationship between intraoperative bile culture outcomes and subsequent postoperative infectious complications. Among patients with bactobilia, a significant 35.1% exhibited systemic or local infectious complications, whereas only 11.1% of those with negative culture results experienced any infectious complications (p=0.002). Similarly, a notable difference was observed in the incidence of surgical site infections, with 24.3% in the bactobilia group compared to 7.9% in the negative culture group (p=0.01). A total of 74 monomicrobial cultures with microbiological growth were isolated, predominantly featuring Gram-negative microorganisms, primarily Enterobacteriaceae in 49 cultures. Escherichia coli was identified in 37.8% of positive cultures, while Klebsiella pneumoniae was evident in 21.6%. Gram-positive microorganisms were present in 10 cultures, with Enterococcus emerging as the prevailing species. The logistic regression model identified a positive bile culture as an independent factor significantly associated with infection development (OR: 2.26; 95% confidence interval: 1.23-11; p=0.02). Considering the limitations of the study, these findings underscore the critical importance of conducting bile cultures during the intraoperative phase to enable vigilant monitoring and prompt management of infectious complications.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Relationship between Intraoperative Bile Culture Outcomes and Subsequent Postoperative Infectious Complications: A Retrospective Cohort Study

Ramírez-Arbeláez,

Arroyave-Zuluaga,

Barrera-Lozano

et al. 2024

BioMed Research International

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“…Finally, while the total number of patients with postoperative culture data available was small, the results are instructive in the potential utility of IOBC to guide postoperative therapy. This strategy has been advocated in multiple previous studies, noting relatively high rates of concordance between IOBC and postoperative infections 26 . More recently, some studies have called this association into question given the relatively high likelihood of microbes that were not present on IOBC populating postoperative infections 12 .…”

Section: Discussionmentioning

confidence: 99%

“…This strategy has been advocated in multiple previous studies, noting relatively high rates of concordance between IOBC and postoperative infections. 26 More recently, some studies have called this association into question given the relatively high likelihood of microbes that were not present on IOBC populating postoperative infections. 12 In the authors' opinion, the results of the present analysis yield credence to the concept of empirically treating based on IOBC results, as more than half of postoperative infections grew microbes present on IOBC.…”

Section: Discussionmentioning

confidence: 99%

Association Between Biliary Pathogens, Surgical Site Infection, and Pancreatic Fistula

et al. 2023

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Objective: Establish the association between bactibilia and postoperative complications when stratified by perioperative antibiotic prophylaxis. Background: Patients undergoing pancreatoduodenectomy (PD) experience high rates of surgical site infection (SSI) and clinically relevant postoperative pancreatic fistula (CR-POPF). Contaminated bile is known to be associated with SSI, but the role of antibiotic prophylaxis in mitigation of infectious risks is ill-defined. Methods: Intraoperative bile cultures (IOBC) were collected as an adjunct to a randomized phase 3 clinical trial comparing piperacillin-tazobactam with cefoxitin as perioperative prophylaxis in patients undergoing PD. After complication of IOBC data, associations between culture results, SSI, and CR-POPF were assessed using logistic regression stratified by the presence of a preoperative biliary stent. Results: Of 778 participants in the clinical trial, IOBC were available for 247 participants. Overall, 68 (27.5%) grew no organisms, 37 (15.0%) grew one organism, and 142 (57.5%) were polymicrobial. Organisms resistant to cefoxitin but not piperacillin-tazobactam were present in 95 patients (45.2%). The presence of cefoxitin-resistant organisms, 92.6% of which contained either Enterobacter or Enterococcus species, was associated with development of SSI in participants treated with cefoxitin (53.5% vs 25.0%; OR 3.44, 95%CI 1.50-7.91; P=0.004) but not those treated with piperacillin-tazobactam (13.5% vs 27.0%; OR 0.42, 95%CI 0.14-1.29; P=0.128). Similarly, cefoxitin-resistant organisms were associated with CR-POPF in participants treated with cefoxitin (24.1% vs 5.8%; OR 3.45, 95%CI 1.22-9.74; P=0.017) but not those treated with piperacillin-tazobactam (5.4% vs 4.8%; OR 0.92, 95%CI 0.30-2.80; P=0.888). Conclusion: Previously observed reductions in SSI and CR-POPF in patients that received piperacillin-tazobactam antibiotic prophylaxis are potentially mediated by biliary pathogens that are cefoxitin resistant, specifically Enterobacter spp and Enterococcus spp.

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“…Moreover, when there is not a safe route for a direct percutaneous biopsy, a cytologic brushing of pancreatic stenosis through a percutaneous access to the biliary tract can be used. In patients with jaundice, surgery increases the risk of postoperative complications; as such, preoperative biliary drainage improves the postoperative outcome [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Interventional Radiology in the Treatment of Pancreatic Adenocarcinoma: Present and Future Perspectives

Punzi

Carrubba

Contegiacomo

et al. 2023

Life

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Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease; patients’ long-term survival is strictly linked to the surgical resection of the tumor but only a minority of patients (2–3%) have a resectable disease at diagnosis. In patients with surgically unresectable disease, interventional radiology is taking on an increasing role in treatment with the application of loco-regional percutaneous therapies. The primary purposes of this narrative review are to analyze the safety and efficacy of ablative techniques in the management of borderline resectable and locally advanced diseases and to underline the role of the interventional radiologist in the management of patients with distant metastases. The secondary purpose is to focus on the synergy between immunotherapy and ablative therapies.

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A meta-analysis and systematic review of intraoperative bile cultures association with postoperative complications in pancreaticoduodenectomy

Cited by 6 publications

References 25 publications

Relationship between Intraoperative Bile Culture Outcomes and Subsequent Postoperative Infectious Complications: A Retrospective Cohort Study

Relationship between Intraoperative Bile Culture Outcomes and Subsequent Postoperative Infectious Complications: A Retrospective Cohort Study

Association Between Biliary Pathogens, Surgical Site Infection, and Pancreatic Fistula

Interventional Radiology in the Treatment of Pancreatic Adenocarcinoma: Present and Future Perspectives

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