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Published in:

01-11-2014

Perioperative Antibiotics Covering Bile Contamination Prevent Abdominal Infectious Complications After Pancreatoduodenectomy in Patients With Preoperative Biliary Drainage

Authors: Takeshi Sudo, Yoshiaki Murakami, Kenichiro Uemura, Yasushi Hashimoto, Naru Kondo, Naoya Nakagawa, Hiroki Ohge, Taijiro Sueda

Published in: World Journal of Surgery | Issue 11/2014

Abstract

Background

Although bile contamination caused by preoperative biliary drainage (PBD) is a risk factor for infectious complications after pancreatoduodenectomy, the appropriate perioperative antibiotic regimen remains unclear. We evaluated a perioperative antibiotic strategy targeting bile contamination associated with PBD procedures for preventing abdominal infectious complications after pancreatoduodenectomy.

Methods

Consecutive patients (n = 254) underwent pancreatoduodenectomy at a single center. Perioperative antibiotics were mainly cefazolin in non-PBD cases (n = 116) and cefozopran in internal-PBD cases (n = 87). They were based on preoperative bile cultures in 51 of the external-PBD cases. Intraoperative bile cultures were examined prospectively. Morbidity and abdominal infectious complication rates were evaluated.

Results

The incidence of positive intraoperative bile cultures was significantly higher in the internal-PBD (85 %) and external-PBD (90 %) cases than in the non-PBD cases (26 %) (p < 0.001). The 91 % susceptibility to cefazolin for non-PBD was significantly higher than the 61 % for internal-PBD or 45 % for external-PBD (p < 0.001). Overall morbidity rates (23, 23, and 25 %) and abdominal infectious complications (13, 17, and 14 %) did not differ among the non-PBD, internal-PBD, and external-PBD cases, respectively. Only susceptibility to perioperative antibiotics of biliary microorganisms classified as resistant was a significant independent risk factor for abdominal infectious complications (p = 0.003).

Conclusions

A perioperative antibiotic strategy particular to PBD procedures is valid for covering biliary microorganisms during pancreatoduodenectomy. Perioperative antibiotics covering bile contamination may prevent abdominal infectious complications after pancreatoduodenectomy in patients with and without PBD.

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Title: Perioperative Antibiotics Covering Bile Contamination Prevent Abdominal Infectious Complications After Pancreatoduodenectomy in Patients With Preoperative Biliary Drainage
Authors: Takeshi Sudo
Yoshiaki Murakami
Kenichiro Uemura
Yasushi Hashimoto
Naru Kondo
Naoya Nakagawa
Hiroki Ohge
Taijiro Sueda
Publication date: 01-11-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 11/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2688-7

At a glance: The STEP trials

Springer Medicine

Perioperative Antibiotics Covering Bile Contamination Prevent Abdominal Infectious Complications After Pancreatoduodenectomy in Patients With Preoperative Biliary Drainage

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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