Top

Published in:

01-11-2007

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

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

Published in: World Journal of Surgery | Issue 11/2007

Abstract

Background

Preoperative biliary drainage (PBD) is associated with bacterial contamination of bile, but the effects of PBD on morbidity after pancreatoduodenectomy remain controversial. The aim of this study was to characterize bile contamination to develop successful specific antibiotic prophylactic strategies for pancreatoduodenectomy.

Methods

Ninety-one consecutive patients who underwent pancreatoduodenectomy for periampullary tumor were prospectively evaluated. Prophylactic antibiotics were selected based on preoperative bile cultures. Bile cultures and postoperative complications were compared in 46 patients who underwent PBD (drainage group) versus 45 patients who did not (nondrainage group).

Results

The incidence of positive bile cultures was higher in the drainage group (78%) than in the nondrainage group (36%) (P < 0.001). In the drainage group, positive bile cultures were frequently polymicrobial (61%) and demonstrated resistance to several antibiotics, including cefazolin (83%), cefmetazole (72%), and cefpirome (64%). Overall morbidity (30% and 22%) and infectious morbidity (13% and 11%) did not differ significantly between the drainage and nondrainage groups, respectively.

Conclusions

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.

Yeo CJ, Cameron JL, Sohn TA, et al. (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226(3):248–257; discussion 257–260PubMedCrossRef

Buchler MW, Friess H, Wagner M, et al. (2000) Pancreatic fistula after pancreatic head resection. Br J Surg 87(7):883–889PubMedCrossRef

Ho V, Heslin MJ (2003) Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg 237(4):509–514PubMedCrossRef

Tran KT, Smeenk HG, van Eijck CH, et al. (2004) Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 240(5):738–745PubMedCrossRef

Duffas JP, Suc B, Msika S, et al. (2005) A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy. Am J Surg 189(6):720–729PubMedCrossRef

Povoski SP, Karpeh MS Jr, Conlon KC, et al. (1999) Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy. Ann Surg 230(2):131–142PubMedCrossRef

Pisters PW, Hudec WA, Hess KR, et al. (2001) Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients. Ann Surg 234(1):47–55PubMedCrossRef

Saleh MM, Norregaard P, Jorgensen HL, et al. (2002) Preoperative endoscopic stent placement before pancreaticoduodenectomy: a meta-analysis of the effect on morbidity and mortality. Gastrointest Endosc 56(4):529–534PubMedCrossRef

Sewnath ME, Karsten TM, Prins MH, et al. (2002) A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg 236(1):17–27PubMedCrossRef

10.

Martignoni ME, Wagner M, Krahenbuhl L, et al. (2001) Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy. Am J Surg 181(1):52–59; discussion 87PubMedCrossRef

11.

Sewnath ME, Birjmohun RS, Rauws EA, et al. (2001) The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy. J Am Coll Surg 192(6):726–734PubMedCrossRef

12.

Hodul P, Creech S, Pickleman J, et al. (2003) The effect of preoperative biliary stenting on postoperative complications after pancreaticoduodenectomy. Am J Surg 186(5):420–425PubMedCrossRef

13.

Povoski SP, Karpeh MS Jr, Conlon KC, et al. (1999) Preoperative biliary drainage: impact on intraoperative bile cultures and infectious morbidity and mortality after pancreaticoduodenectomy. J Gastrointest Surg 3(5):496–505PubMedCrossRef

14.

Cortes A, Sauvanet A, Bert F, et al. (2006) Effect of bile contamination on immediate outcomes after pancreaticoduodenectomy for tumor. J Am Coll Surg 202(1):93–99PubMedCrossRef

15.

Wells GR, Taylor EW, Lindsay G, et al. (1989) Relationship between bile colonization, high-risk factors and postoperative sepsis in patients undergoing biliary tract operations while receiving a prophylactic antibiotic. West of Scotland Surgical Infection Study Group. Br J Surg 76(4):374–377PubMedCrossRef

16.

Fan ST, Lai EC, Wong J (1993) Hepatic resection for hepatolithiasis. Arch Surg 128(9):1070–1074PubMed

17.

Shigeta H, Nagino M, Kamiya J, et al. (2002) Bacteremia after hepatectomy: an analysis of a single-center, 10-year experience with 407 patients. Langenbecks Arch Surg 387(3–4):117–124PubMedCrossRef

18.

Bassi C, Dervenis C, Butturini G, et al. (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13PubMedCrossRef

19.

Dixon JM, Armstrong CP, Duffy SW, et al. (1983) Factors affecting morbidity and mortality after surgery for obstructive jaundice: a review of 373 patients. Gut 24(9):845–852PubMedCrossRef

20.

Kimmings AN, van Deventer SJ, Obertop H, et al. (2000) Endotoxin, cytokines, and endotoxin binding proteins in obstructive jaundice and after preoperative biliary drainage. Gut 46(5):725–731PubMedCrossRef

21.

Karsten TM, Allema JH, Reinders M, et al. (1996) Preoperative biliary drainage, colonisation of bile and postoperative complications in patients with tumours of the pancreatic head: a retrospective analysis of 241 consecutive patients. Eur J Surg 162(11):881–888PubMed

22.

Jagannath P, Dhir V, Shrikhande S, et al. (2005) Effect of preoperative biliary stenting on immediate outcome after pancreaticoduodenectomy. Br J Surg 92(3):356–361PubMedCrossRef

23.

Ueno T, Yamamoto K, Kawaoka T, et al. (2005) Current antibiotic prophylaxis in pancreatoduodenectomy in Japan. J Hepatobiliary Pancreat Surg 12(4):304–309PubMedCrossRef

Title: Specific Antibiotic Prophylaxis Based on Bile Cultures Is Required to Prevent Postoperative Infectious Complications in Pancreatoduodenectomy Patients Who Have Undergone Preoperative Biliary Drainage
Authors: Takeshi Sudo
Yoshiaki Murakami
Kenichiro Uemura
Yasuo Hayashidani
Yasushi Hashimoto
Hiroki Ohge
Taijiro Sueda
Publication date: 01-11-2007
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 11/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-007-9210-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2007

Conventional Versus Invaginated Stripping of the Great Saphenous Vein: A Randomized, Double-Blind, Controlled Clinical Trial

Aortopexy in Infants and Children—Long-term Follow-up in Twenty Patients

Partial Splenectomy for Benign Splenic Cysts with the Aid of a Lin Clamp: Technical Note

Laparoscopıc Fundoplicatıon with Prosthetic Hiatal Closure

Ethics of Surgical Training in Developing Countries

Lateral Mobilization of the Recurrent Laryngeal Nerve to Facilitate Tracheal Surgery in Patients with Thyroid Cancer Invading the Trachea Near Berry’s Ligament