Surgical site infections after pancreaticoduodenectomy: Preoperative biliary system interventions and antimicrobial prophylaxis

Abstract

Background: The rate of surgical site infection (SSI) after pancreaticoduodenectomy (PD) is high and insertion of preoperative bile duct catheterization (PBDC) predispose a high risk of SSI with multidrug resistant (MDR) microorganisms. Aim: To describe the effects of PBDC and the prophylaxis in development of SSI. Methods: We conducted a retrospective study between January 01, 2010 and December 2018 including the patients with PD and total pancreatectomy. Findings: In total 214 consecutive patients were included. The PBDC was inserted to 63 (29%) patients. The rate of intraoperative bile fluid culture positivity was higher among the patients with PBDC (84% vs. 17% respectively, p < 0.001). The SSI was detected in 52 patients (24%). In multivariate analysis, the rate of SSI was found to be higher among the patients with PBDC (OR: 2.33, 95% Cl: 1.14-4.76, p = 0.02). As the etiologic agents of SSI, Pseudomonas spp. and MDR pathogens were mainly detected in PBDC group. The resistance to ampicillin-sulbactam was significantly higher in the PBDC group (87.5% vs. 25%, p = 0.012). The similar bacterial species both in bile fluid and the surgical site were detected in 11 (21%) patients with SSI. Among 8 patients (15%), antimicrobial susceptibility was the same. Only in five out of 52 (10%) patients, the SSI pathogens was susceptible to the agent that was used for surgical prophylaxis. Conclusion: Unnecessary catheterizations should be avoided. By considering the increasing prevalence of resistant bacteria as the cause of SSI, the clinicians should closely follow-up their patients for choosing the proper antimicrobials.

Effectiveness of Surgical Prophylaxis Where the Antibiotic Resistance is High

“…The problem of antimicrobial resistance is increasing in our country and worldwide (14,15). The MDR bacteria were found to be responsible for the SSI (16). In our study, microorganisms isolated from knee and hip prosthesis infections are resistant to broadspectrum antibiotics.…”

Surgical Site Infections in Patients of Periampullary Carcinoma Undergoing Delayed Bile Duct Division (COMBILAST) in Whipple’s Procedure: A Prospective Cohort Study

“…Based on our modified sequence of Whipple’s procedure, we experienced a significantly lower SSI rate (16.67%) compared to the reported incidences of >20% [ 1 , 4 , 17 , 18 , 19 ]. In our center, as per the monthly audit report and our databases, the SSI rate after PD is about 33% if performed without the COMBILAST sequence and in the absence of a PJ anastomotic leak.…”

Antibiotic Prophylaxis for Hepato-Biliopancreatic Surgery—A Systematic Review

“…Ampicillin/sulbactam resistance was significantly more common in the PBD group (67% vs. 22%, p = 0.002). Meropenem, piperacillin-tazobactam, and ciprofloxacin resistance were also higher, although statistically not significant [ 26 ]. Additionally, in a work by Camman, a retrospective series of 243 patients with hepatobiliary surgery with biliodigestive anastomosis showed that stenting was associated with a higher rate of ampicillin ( p = 0.091, OR = 1.72) and or ciprofloxacin-resistant bacteria ( p < 0.001, OR = 3.48), resulting in 74.2% of all stented patients with a resistant bacterium in the bile [ 27 ].…”

“…Bilgic et al found a significant correlation between SSI rate and preoperative drainage. In 21% of cases, bile fluid and the surgical site presented similar bacterial species [ 26 ]. In a retrospective series by Sugimachi, incisional SSI correlated with multi-drug resistant (MDR) bacteria isolation, but not with organ/space SSI or overall post-operative complications [ 24 ].…”