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World Journal of Surgery

Published in:

01-04-2011

Preoperative Biliary MRSA Infection in Patients Undergoing Hepatobiliary Resection with Cholangiojejunostomy: Incidence, Antibiotic Treatment, and Surgical Outcome

Authors: Daisuke Takara, Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Masato Nagino

Published in: World Journal of Surgery | Issue 4/2011

Abstract

Background

There have been no reports on the impact of preoperative biliary MRSA infection on the outcome of major hepatectomy. The aim of this study was to review the surgical outcome of patients who underwent hepatobiliary resection after biliary drainage and to evaluate the impact of preoperative biliary MRSA infection.

Methods

Medical records from 350 patients who underwent hepatobiliary resection with cholangiojejunostomy after external biliary drainage were retrospectively reviewed.

Results

Of the 350 study patients, 14 (4.0%) had MRSA-positive bile culture, 246 (70.3%) had positive bile culture without MRSA growth, and the remaining 90 (25.7%) had negative bile culture. In all of the patients with MRSA-positive bile culture, vancomycin was prophylactically administered after surgery. Of the 14 patients, 6 (42.9%) had surgical site infections, including wound infection in 5 patients and intra-abdominal abscess in 2 patients. The incidence of surgical site infection in the 14 MRSA-positive patients was higher but not statistically significant compared to the incidence in other patient groups. All 14 patients tolerated difficult hepatobiliary resection. Of the 350 study patients, 28 (8.0%) had postoperative MRSA infections. Multivariate analysis identified preoperative MRSA-positive bile culture as a significant independent risk factor for postoperative MRSA infection.

Conclusions

Preoperative biliary MRSA infection is troublesome as it is an independent risk factor of postoperative MRSA infection. Even in such troublesome situations, however, difficult hepatobiliary resection can be performed with acceptable rates of morbidity and mortality using appropriate antibiotic prophylaxis, including vancomycin, based on bile culture.

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Title: Preoperative Biliary MRSA Infection in Patients Undergoing Hepatobiliary Resection with Cholangiojejunostomy: Incidence, Antibiotic Treatment, and Surgical Outcome
Authors: Daisuke Takara
Gen Sugawara
Tomoki Ebata
Yukihiro Yokoyama
Tsuyoshi Igami
Masato Nagino
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 4/2011
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-011-0990-1

At a glance: The STEP trials

Springer Medicine

Preoperative Biliary MRSA Infection in Patients Undergoing Hepatobiliary Resection with Cholangiojejunostomy: Incidence, Antibiotic Treatment, and Surgical Outcome

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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