Discordance Between Perioperative Antibiotic Prophylaxis and Wound Infection Cultures in Patients Undergoing Pancreaticoduodenectomy

Fong, Zhi Ven; McMillan, Matthew T.; Marchegiani, Giovanni; Sahora, Klaus; Malleo, Giuseppe; Pastena, Matteo De; Loehrer, Andrew P.; Lee, Grace C.; Ferrone, Cristina R.; Chang, David C.; Hutter, Matthew M.; Drebin, Jeffrey A.; Bassi, Claudio; Lillemoe, Keith D.; Vollmer, Charles M.; Castillo, Carlos Fernández del

doi:10.1001/jamasurg.2015.4510

Cited by 108 publications

(92 citation statements)

References 41 publications

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“…Intraoperative specimen cultures were positive in the majority (96%) of patients, which is significantly higher than the rate of 58–87% reported in the literature . This probably reflects the high prevalence of preoperative biliary stenting in our patient cohort as most of the operative specimens from which cultures were obtained were biliary stents rather than swabs or tissue.…”

Section: Discussioncontrasting

confidence: 50%

“…Candida species were cultured in half of the patients whilst other studies report a prevalence of Candida species of 0–26% in intraoperative bile specimens . One multicentre retrospective study compared the results of intraoperative bile and surgical site infection cultures from patients undergoing pancreatoduodenectomy at Massachusetts General Hospital in the USA and the University of Verona Hospital in Italy and demonstrated variability in the isolates between centres, although the prevalence of Candida albicans in intraoperative bile cultures was similar at approximately 13% …”

Section: Discussionmentioning

confidence: 99%

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Microbiology of pancreatoduodenectomy and recommendations for antimicrobial prophylaxis

Swan

Nahm

Samra

et al. 2019

ANZ Journal of Surgery

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Background The microbiology of pancreatoduodenectomy is challenging and published guidelines regarding perioperative antimicrobial prophylaxis are variable with poor adherence. Methods A retrospective analysis of the microbiological results of 294 consecutive patients who underwent pancreatoduodenectomy was performed. Intraoperative specimen culture results were available for 50 patients and their medical records were reviewed to determine the following demographics and factors; age; sex; tumour location, histopathology, grade and stage; neoadjuvant chemotherapy and radiotherapy; preoperative biliary stenting; surgeon; surgery type and antimicrobial prophylaxis coverage. Outcomes assessed included; post‐operative infections, mortality (all and 90‐day), and intensive care unit and hospital admission durations. Univariate analysis with chi‐squared testing was performed. Results Intraoperative specimen cultures were positive in 48 (96%) patients and polymicrobial in 45 (90%) patients with a predominance of Enterobacteriaceae (38/76%), Enterococcus species (27/54%), and Candida species (25/50%). Isolates were potentially susceptible to the current perioperative antimicrobial prophylaxis regimen of ceftriaxone with or without metronidazole in only six patients. However, only neoadjuvant radiotherapy was associated with statistically significant increased intensive care unit and hospital admission durations. Conclusion Although this study was probably underpowered to detect any statistically significant associations, perioperative antimicrobial prophylaxis coverage of the operative field microbiological milieu of pancreatoduodenectomy is logical and current guidelines may be inadequate.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Microbiology of pancreatoduodenectomy and recommendations for antimicrobial prophylaxis

Swan

Nahm

Samra

et al. 2019

ANZ Journal of Surgery

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“…This is consistent with previous studies that support the utility of prior individual culture data in predicting subsequent antibiotic susceptibility patterns in both medical and Surg Infect (Larchmt). (39–41) Knowledge of an individual’s past culture data and related risk for antibiotic-resistant infection is a crucial part of appropriate antibiotic selection for a given patient. (40, 42, 43) A combined approach to SAP based on procedure-specific risks in conjunction with a patient’s own prior culture data could potentially serve to improve clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Surgical Antibiotic Prophylaxis and Risk for Postoperative Antibiotic-Resistant Infections

Cohen

Salmasian

et al. 2017

Journal of the American College of Surgeons

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Background Antibiotic-resistant infections have high rates of morbidity and mortality and exposure to antibiotics is the crucial risk factor for development of antibiotic resistance. If surgical antibiotic prophylaxis (SAP) increases risk for antibiotic-resistant infections, prophylaxis may cause net harm even if it decreases overall infection rates. Study Design This retrospective cohort study included adults who underwent elective surgical procedures and developed infections within 30 post-operative days. Surgeries from multiple disciplines were included if SAP was considered discretionary by current guidelines. Postoperative antibiotic-resistant infections were defined as positive culture results from any site within 30 post-operative days showing intermediate or non-susceptibility across one or more antibiotic classes. SAP included use of antibiotics within any class and at any dose from one hour before first incision until the end of the operation. Results Among 689 adults with post-operative infections, 338 (49%) had post-operative resistant infections. Use of SAP was not associated with post-operative antibiotic-resistant infections (OR 0.99, 95% CI 0.67–1.46). This result remained robust when the SAP definition was extended to antibiotics given within 4 hours before first incision (OR 0.94, 95% CI 0.63–1.40) and when the follow-up window was narrowed to 14 days (OR 0.82, 95% CI 0.50–1.34). Prior antibiotic-resistant infections were associated with risk for post-operative antibiotic-resistant infections (OR 1.81, 95% CI 1.16–2.83). Conclusion Use of SAP was not associated with risk for post-operative antibiotic resistant infections in a large cohort of patients with post-operative infections. This provides important reassurance regarding use of surgical antibiotic prophylaxis.

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“…Despite the different practice patterns at the 3 institutions whose pancreatic databases were queried by Fong et al, 1 the consistent finding was that intraoperative bile cultures predicted the spectrum of postoperative wound infections. In addition, the therapeutic range of the prophylactic antibiotics used did not correspond to the spectrum of wound infection cultures found at each institution.…”

mentioning

confidence: 99%

“…Despite this, all 3 institutions combined had an acceptably low overall wound infection rate of 8.2%. This study 1 ply to all fields of surgery: institution-specific internal reviews should be undertaken to ensure that the prophylactic antibiotic chosen actually covers the organisms identified in wound infections for that institution. It seems that infections, like politics, are local.…”

mentioning

confidence: 99%

Wound Infections After Pancreaticoduodenectomy

Schoeniger

Linehan

2016

JAMA Surg

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Discordance Between Perioperative Antibiotic Prophylaxis and Wound Infection Cultures in Patients Undergoing Pancreaticoduodenectomy

Cited by 108 publications

References 41 publications

Microbiology of pancreatoduodenectomy and recommendations for antimicrobial prophylaxis

Microbiology of pancreatoduodenectomy and recommendations for antimicrobial prophylaxis

Surgical Antibiotic Prophylaxis and Risk for Postoperative Antibiotic-Resistant Infections

Wound Infections After Pancreaticoduodenectomy

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