Bacterobilia in pancreatic surgery-conclusions for perioperative antibiotic prophylaxis  

作　　者：Colin Markus Kruger Ulrich Adam Thomas Adam Axel Kramer Claus D Heidecke Frank Makowiec Hartwig Riediger 

机构地区：[1]Department of Surgery,Immanuel Hospital Rüdersdorf,Berlin 15562,Germany [2]Department of General Surgery,Vivantes-Humboldt hospital,Berlin 13503,Germany [3]Department of Microbiology,Labor Berlin GmbH,Berlin 13353,Germany [4]Institute of Hygiene and Environmental Medicine,University Medicine Greifswald,Greifswald 17495,Mecklenburg Vorpommern,Germany [5]Department of Surgery,Clinic of General,Visceral,Vascular and Thoracic Surgery,University Medicine Greifswald,Greifswald 17475,Mecklenburg Vorpommern,Germany [6]Section of clinical risk assessment,University hospital of Freiburg,Freiburg 79106,Baden-Württemberg,Germany

出　　处：《World Journal of Gastroenterology》2019年第41期6238-6247,共10页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND Jaundice or preoperative cholestasis(PC)are typical symptoms of pancreatic masses.Approximately 50%of patients undergo preoperative biliary drainage(PBD)placement.PBD is a common cause of bacterobilia(BB)and is a known surgical site infection risk factor.An adjustment of preoperative antibiotic prophylaxis(PAP)may be reasonable according to the profile of BB.For this,we examined the microbiological findings in routine series of patients.AIM To investigate the incidence and profile of biliary bacterial colonization in patients undergoing pancreatic head resections.METHODS In the period from January 2009 to December 2015,285 consecutive pancreatic head resections were performed.Indications for surgery were malignancy(71%),chronic pancreatitis(18%),and others(11%).A PBD was in 51%and PC was in 42%.The standard PAP was ampicillin/sulbactam.Intraoperatively,a smear was taken from the hepatic duct.An analysis of the isolated species and resistograms was performed.Patients were categorized according to the presence or absence of PC(PC+/PC-)and PBD(PBD+/PBD-)into four groups.Antibiotic efficiency was analyzed for standard PAP and possible alternatives.RESULTS BB was present in 150 patients(53%).BB was significantly more frequent in PBD+(n=120)than in PBD-(n=30),P<0.01.BB was present both in patients with PC and without PC:(PBD-/PC-:18%,PBD-/PC+:30%,PBD+/PC-:88%,PBD+/PC+:80%).BB was more frequent in malignancy(56%)than in chronic pancreatitis(45%).PBD,however,was the only independent risk factor in multivariate analysis.In total,357 pathogens(342 bacteria and 15 fungi)were detected.The five most common groups(n=256,74.8%)were Enterococcus spp.(28.4%),Streptococcus spp.(16.9%),Klebsiella spp.(12.6%),Escherichia coli(10.5%),and Enterobacter spp.(6.4%).A polymicrobial BB(PBD+:77% vs PBD-:40%,P<0.01)and a more frequent detection of Enterococcus(P<0.05)was significantly associated with PBD+.In PBD+,the efficiency of imipenem and piperacillin/tazobactam was significantly higher than that of the standard PAP(P<0.01).CBACKGROUND Jaundice or preoperative cholestasis(PC) are typical symptoms of pancreatic masses. Approximately 50% of patients undergo preoperative biliary drainage(PBD) placement. PBD is a common cause of bacterobilia(BB) and is a known surgical site infection risk factor. An adjustment of preoperative antibiotic prophylaxis(PAP) may be reasonable according to the profile of BB. For this, we examined the microbiological findings in routine series of patients.AIM To investigate the incidence and profile of biliary bacterial colonization in patients undergoing pancreatic head resections.METHODS In the period from January 2009 to December 2015, 285 consecutive pancreatic head resections were performed. Indications for surgery were malignancy(71%),chronic pancreatitis(18%), and others(11%). A PBD was in 51% and PC was in42%. The standard PAP was ampicillin/sulbactam. Intraoperatively, a smear was taken from the hepatic duct. An analysis of the isolated species and resistograms was performed. Patients were categorized according to the presence or absence of PC(PC+/PC-) and PBD(PBD+/PBD-) into four groups. Antibiotic efficiency was analyzed for standard PAP and possible alternatives.RESULTS BB was present in 150 patients(53%). BB was significantly more frequent in PBD+(n =120) than in PBD-(n = 30), P < 0.01. BB was present both in patients with PC and without PC:(PBD-/PC-: 18%, PBD-/PC+: 30%, PBD+/PC-: 88%, PBD+/PC+:80%). BB was more frequent in malignancy(56%) than in chronic pancreatitis(45%). PBD, however, was the only independent risk factor in multivariate analysis. In total, 357 pathogens(342 bacteria and 15 fungi) were detected. The five most common groups(n = 256, 74.8%) were Enterococcus spp.(28.4%),Streptococcus spp.(16.9%), Klebsiella spp.(12.6%), Escherichia coli(10.5%), and Enterobacter spp.(6.4%). A polymicrobial BB(PBD+: 77% vs PBD-: 40%, P < 0.01)and a more frequent detection of Enterococcus(P < 0.05) was significantly associated with PBD+. In PBD+, the efficiency of imipenem and piperacillin/tazobactam

关 键 词：PANCREATIC surgery Bacteriobilia Antibiotic PROPHYLAXIS CHOLESTASIS CHOLANGIOPANCREATOGRAPHY Endoscopic RETROGRADE 

分 类 号：R57[医药卫生—消化系统]