Prognostic Impact of Bacterobilia on Morbidity and Postoperative Management After Pancreatoduodenectomy: A Systematic Review and Meta‐analysis

Müssle, Benjamin; Hempel, Simone; Kahlert, Christoph; Distler, Marius; Weitz, Jürgen; Welsch, Thilo

doi:10.1007/s00268-018-4546-5

Cited by 52 publications

(56 citation statements)

References 71 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fong et al [26], demonstrating a close correlation between organisms cultured from perioperative bile sampling and those subsequently seen in cultures from SSIs, with gutderived organisms identified in the majority of cases. In a systematic review and meta-analysis, Müssle et al [27] noted a median incidence of bacterobilia of 58%, and that intraoperative bile cultures and postoperative infections correlated in around 50% of cases. Furthermore, Ohgi et al [28] studied 264 patients and found in a multivariable analysis that positive intra-operative bile cultures were associated with clinically important pancreatic fistulae.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship Reduces Surgical Site Infection Rate, as well as Number and Severity of Pancreatic Fistulae after Pancreatoduodenectomy

Cengiz

Jarrar

Power

et al. 2020

Surgical Infections

View full text Add to dashboard Cite

Background: Surgical site infections (SSIs) remain a major source of morbidity after pancreatoduodenectomy (PD). We noted a higher than anticipated incidence of SSI in our patients undergoing PD, and after an internal audit and detailed analysis of the microflora of SSIs, as well as a multidisciplinary discussion, the local prophylactic antibiotic policy was changed based on sensitivities to the bacteria isolated from post-operative infections. The hypothesis was that a targeted change in antibiotic prophylaxis would reduce the rate of SSIs. The aim of the current study was to analyze the results of a change in prescribing policy on SSI rates, and in addition, on the occurrence and severity of post-operative pancreatic fistulae (POPF) because this complication is often linked to the presence of an organ/space SSI. Methods: After implementing a change of prophylaxis policy from cefalexin to ceftriaxone and metronidazole, and educating staff and residents, a prospectively maintained departmental database was used to identify consecutive patients undergoing PD pre-and post-institution of policy change. Incidence data relating to SSIs and POPF were obtained from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) data set and the details of culture results and organism sensitivity extracted from the electronic medical record, as were details on the severity of fistulae, and verified by the senior author. Results: The pre-and post-implementation cohorts consisted of 111 and 216 patients, respectively, and were matched in terms of all demographic features. After the change in the antibiotic prophylaxis policy, there was a reduction in the overall SSI rate (26.4% vs. 14.8%; p = 0.01) and the organ/space SSI rate (OS-SSI; 15.3% vs. 8.6%; p = 0.03). There were also reductions in the POPF rate (38.2% vs. 19%; p = 0.002) and in the clinically relevant POPF (CR-POPF; 23.4% vs. 6.0%; p = 0.001). The rate of Clostridium difficile infections also decreased (8.1% vs.1.9%; p = 0.006) as did the median length of hospital stay (7 vs. 6 days; p = 0.003). After excluding patients with a penicillin allergy (n = 24) from the post-implementation cohort, cases compliant (158/ 192) and non-compliant (34/192) to the new antibiotic policy were compared. The overall SSI (26.4% vs. 10.7%; p = 0.025), OS-SSI (17.6% vs. 5.1%; p = 0.021), overall POPF (32.4 vs. 14.6; p = 0.023); CR-POPF (10.8% vs. 5.5%; p = 0.047) and Clostridium difficile (8.8% vs. 1.3%; p = 0.040) were all lower in the compliant patient cohort. Conclusions: A change in antibiotic prophylaxis prior to PD based on the local microflora, resulted in reductions in SSI, POPF, and Clostridium difficile rates.

show abstract

Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship Reduces Surgical Site Infection Rate, as well as Number and Severity of Pancreatic Fistulae after Pancreatoduodenectomy

Cengiz

Jarrar

Power

et al. 2020

Surgical Infections

View full text Add to dashboard Cite

show abstract

“…15 The mortality of patients undergoing pancreatoduodenectomy that developed biliary infection was reported as 5.9% in a review article. 16 Compared with these data, our mortality rate of 13.5% (7/52) among patients carrying A hydrophila after pancreatoduodenectomy or hepatectomy with biliary reconstruction was quite high. Moreover, the clinical course of these patients was rapid, and most of them died within 3 days after the onset.…”

Section: Discussionmentioning

confidence: 60%

Mortality analysis of Aeromonas hydrophila infection in hepato‐biliary pancreatic surgery: Multicenter retrospective observational study

Ueno

Iida

Kaibori

et al. 2020

J Hepato Biliary Pancreat

View full text Add to dashboard Cite

Background/Purpose: Aeromonas hydrophila can cause lethal infectious complications after surgery. There have been no large cohort studies of this specific to the hepato-biliary-pancreatic (HBP) field. We investigate the postoperative influence of A hydrophila infection after HBP surgery. Methods: We retrospectively reviewed patients who underwent HBP surgery between 2008 and 2017 at eight university hospitals. Patients with A hydrophila isolation during perioperative management were extracted, and their postoperative courses were investigated. Results: Bacterial culture examination of 10 074 patients was performed as perioperative management. Among them, 76 patients (0.75%) had A hydrophila isolation, most of whom underwent pancreatoduodenectomy (n = 38) or hepatectomy with biliary reconstruction (n = 14). There were seven mortalities after these two procedures (13.5%), five within 3 days after the onset of infection. Bile (n = 48) and abdominal drainage fluid (n = 29) were major sites of A hydrophila isolation. Typical prophylactic antibiotics, cefazolin or flomoxef, were mostly resistant. There was no mortality among patients that received sensitive antibiotics prophylactically. Conclusions: Isolation of A hydrophila was low in our cases of HBP surgery, but the condition of some patients deteriorated rapidly by this infection. Although there could be several bacterial infections during management of HBP surgery, A hydrophila should not be overlooked. Preparation of appropriate prophylactic antibiotics may prevent or reduce mortality.

show abstract

“…For population PK modeling, NONMEM 7.3 (Icon Development Solutions, Ellicott City, Maryland) was used and executed via PsN (V4.4.0 [2]). Interindividual variability was implemented on the structural PK parameters as follows:…”

Section: Population Pk Analysismentioning

confidence: 99%

“…Postoperative local infection after pancreas resection occurs in up to 20% of patients and may lead to potentially major complications. Patients at risk for infected fluid collections after pancreatic surgery are predominantly but not exclusively patients who were preoperatively treated for jaundice and received interventional bile duct stenting . Infections of peripancreatic fluid collections possibly contribute to postoperative complications such as pancreatic fistula formation, which is the strongest factor for postoperative morbidity after pancreas resection.…”

mentioning

confidence: 99%

“…Patients at risk for infected fluid collections after pancreatic surgery are predominantly but not exclusively patients who were preoperatively treated for jaundice and received interventional bile duct stenting. 1,2 Infections of peripancreatic fluid collections possibly contribute to postoperative complications such as pancreatic fistula formation, which is the strongest factor for postoperative morbidity after pancreas resection. Apart from interventional or surgical drainage, antibiotic therapy is a crucial pillar to lower the rate of postoperative complications such as secondary infection of primarily sterile pancreatic fistulas.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Is Moxifloxacin a Treatment Option for Pancreatic Infections? A Pharmacometric Analysis of Serum and Pancreatic Juice

Wicha

Mundkowski

Klock

et al. 2019

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Postoperative local infection is a major complication after pancreatic surgery. The aim of this prospective clinical trial was to assess the potential of moxifloxacin (MXF) to treat pancreatic infections from a pharmacokinetic (PK)/pharmacodynamic (PD) perspective. The PK of MXF in serum and pancreatic juice, via an inserted tube in the pancreatic duct, was determined in 19 patients up to day 7 after pancreatoduodenectomy. PK data in both specimens was analyzed with NONMEM 7.3. Intraoperative swipes were performed for microbiological examination. PK/PD target attainment was assessed in both matrices using unbound area under the plasma concentration–time curve/minimum inhibitory concentration (MIC) targets of ≥30 and ≥100, for gram‐positive and gram‐negative pathogens, respectively. A 2‐compartment population PK model in which the measurements in pancreatic juice were assigned to a scaled peripheral compartment best described the PK in both specimens simultaneously. Median (10th–90th percentile) area under the plasma concentration–time curve values after the third dose were 28.9 mg · h/L (18.6–42.0) in serum and 55.8 mg · h/L (23.7–81.4) in pancreatic juice. Target attainment rate for the intraoperatively isolated bacterial strains was ≥0.88 after the third MXF dose. For gram‐negatives, high probability of target attainment ≥0.84 was observed in serum for MIC ≤ 0.125 mg/L and in pancreatic juice for MIC ≤ 0.25 mg/L. For gram‐positives, the probability of target attainment was 0.84–1 in serum for MIC ≤ 0.5 mg/L and in pancreatic juice for MIC ≤ 1 mg/L. In conclusion, penetration of MXF into pancreatic juice was substantial. The PK/PD analysis indicated that treatment of pancreatic infections by isolates with MIC ≤ 0.25 mg/L (gram‐negative) and ≤1 mg/L (gram‐positive) should be evaluated in further studies.

show abstract

Prognostic Impact of Bacterobilia on Morbidity and Postoperative Management After Pancreatoduodenectomy: A Systematic Review and Meta‐analysis

Cited by 52 publications

References 71 publications

Antimicrobial Stewardship Reduces Surgical Site Infection Rate, as well as Number and Severity of Pancreatic Fistulae after Pancreatoduodenectomy

Antimicrobial Stewardship Reduces Surgical Site Infection Rate, as well as Number and Severity of Pancreatic Fistulae after Pancreatoduodenectomy

Mortality analysis of Aeromonas hydrophila infection in hepato‐biliary pancreatic surgery: Multicenter retrospective observational study

Is Moxifloxacin a Treatment Option for Pancreatic Infections? A Pharmacometric Analysis of Serum and Pancreatic Juice

Contact Info

Product

Resources

About