Specific Antibiotic Prophylaxis Based on Bile Cultures Is Required to Prevent Postoperative Infectious Complications in Pancreatoduodenectomy Patients Who Have Undergone Preoperative Biliary Drainage

Sudo, Takeshi; Murakami, Yoshiaki; Uemura, Kenichiro; Hayashidani, Yasuo; Hashimoto, Yasushi; Ohge, Hiroki; Sueda, Taijiro

doi:10.1007/s00268-007-9210-4

Cited by 84 publications

(102 citation statements)

References 36 publications

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“…This study documents the microbiological milieu of the surgical field in patients undergoing pancreatoduodenectomy. We observed a predominance of Enterobacteriaceae and Enterococcus species, which is concordant with other studies with similar methodologies . 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 .…”

Section: Discussionsupporting

confidence: 92%

“…We observed a predominance of Enterobacteriaceae and Enterococcus species, which is concordant with other studies with similar methodologies . 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: Discussionsupporting

confidence: 92%

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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: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Microbiology of pancreatoduodenectomy and recommendations for antimicrobial prophylaxis

Swan

Nahm

Samra

et al. 2019

ANZ Journal of Surgery

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“…25 Positive bile cultures secondary to PBD have been linked to infectious complications in other retrospective studies. 18,26,27 There was a statistical trend toward an increased risk of death in the no PBD patients. Among the five patients who died postoperatively, two had known operative complications at the time of their death; one patient had an anastomotic leak and the other patient died secondary to a portal vein thrombosis.…”

Section: Discussionmentioning

confidence: 90%

A Matched Case-Control Study of Preoperative Biliary Drainage in Patients with Pancreatic Adenocarcinoma: Routine Drainage Is Not Justified

Mezhir

Brennan

Baser

et al. 2009

Journal of Gastrointestinal Surgery

109

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“…However, there are inevitably situations in which PBD must be carried out before PD, for example, pre-operative therapy for pancreatic cancer and preoperative evaluation for tumor extension of bile duct cancer. Sudo et al pointed out that PBD had a notable influence on bile microbial contamination and therefore recommended specific antibiotic prophylaxis for 4 or 5 days post-operatively, based on bile culture results, to prevent infectious complications in pancreatoduodenectomy patients who undergo PBD (22). Routine antibiotic prophylaxis relying on broadspectrum cephalosporins for a long time may be adequate for patients who must undergo PBD.…”

Section: Discussion Discussionmentioning

confidence: 99%

Optimal Duration of Prophylactic Antibiotics Administration in Pancreaticoduodenectomy

Yamamoto¹,

Satoi²,

Yanagimoto³

et al. 2017

SGO

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Purpose: Pancreaticoduodenectomy (PD) is considered a complex surgical procedure that is associated with a high morbidity. There has been no report on the optimal duration of prophylactic antibiotics administration to date. Mortality and morbidity, including surgical site infection (SSI) after PD, were compared retrospectively taking into account the period of prophylactic antibiotics administration. Methods: This study involved 158 patients who underwent PD between April 2006 and December 2010. Until March 2008 our hospital administered prophylactic antibiotics until post-operative day-2, but beginning in April 2008 they were administered only until postoperative day-1. Group A consisted of 71 consecutively treated patients who received cefmetazole (CMZ) as a prophylactic antibiotic intra-operatively and for 2 days postoperatively. Group B consisted of 87 consecutively treated patients who received CMZ intraoperatively and for 1 day post-operatively. During the study period, peri-operative management was standardized according to our departmental guidelines. Results: There were no significant differences in post-operative complications between the two groups. The most commonly isolated microorganisms from surgical drainage fluid were Enterobacter and Enterococcus species. Pre-operative biliary drainage was an independent risk factor for SSI (p<0.05). Conclusion: Limiting prophylactic antibiotics administration until post-operative day-1 did not increase morbidity after PD. However, we recommend long-term administration of prophylactic antibiotics for patients who undergo pre-operative biliary drainage.

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Specific Antibiotic Prophylaxis Based on Bile Cultures Is Required to Prevent Postoperative Infectious Complications in Pancreatoduodenectomy Patients Who Have Undergone Preoperative Biliary Drainage

Abstract: PBD had a notable influence on bile microbial contamination, including a higher rate of antibiotic resistance. Therefore, specific antibiotic prophylaxis based on bile culture is required for preventing infectious complications in pancreatoduodenectomy patients who undergo PBD.

Cited by 84 publications

References 36 publications

Microbiology of pancreatoduodenectomy and recommendations for antimicrobial prophylaxis

Microbiology of pancreatoduodenectomy and recommendations for antimicrobial prophylaxis

A Matched Case-Control Study of Preoperative Biliary Drainage in Patients with Pancreatic Adenocarcinoma: Routine Drainage Is Not Justified

Optimal Duration of Prophylactic Antibiotics Administration in Pancreaticoduodenectomy

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