Intraoperative gram staining of bile for the prevention of infectious complications in pancreaticoduodenectomy
Copyright © 2021 AEC. Published by Elsevier España, S.L.U. All rights reserved..
INTRODUCTION: Infectious complications play a prominent role in pancreaticoduodenectomy. Their incidence increases in cases with preoperative biliary drainage (PBD), due to the higher risk of bacterobilia. The aim of this study is to evaluate an antibiotherapy protocol based on intraoperative gram staining of bile and its impact on postoperative infectious complications.
METHODS: A retrospective study analysing the incidence of infectious complications between two groups of 25 consecutive patients undergoing pancreaticoduodenectomy. In group 1, cefazolin prophylaxis was administered to patients without PBD. In cases with PBD a five days antibiotherapy with piperacillin-tazobactam was administered. In group 2, intraoperative gram staining of bile was routinely performed. If no microorganisms were detected, antibiotherapy was limited to cefazolin prophylaxis. If bacterobilia was detected, targeted antibiotherapy was administered for five days.
RESULTS: The incidence of sepsis and organ/space infection in group 2 was 4% compared to 32% and 24% in group 1 respectively (p < 0.05). No differences were observed in the remaining morbimortality variables. The most prevalent microorganisms in bile were Enterococcus spp. and Klebsiella spp. In postoperative samples, they only appeared in 4% of cases in group 2 (p < 0.05), in favour of S. epidermidis, although they were also prevalent in group 1 (28 and 24% respectively).
CONCLUSION: Intraoperative gram staining of bile fluid could be a useful tool to conduct personalised antibiotic therapy in pancreaticoduodenectomy and contribute to the control of infectious complications.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:100 |
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| Enthalten in: |
Cirugia espanola - 100(2022), 8 vom: 10. Aug., Seite 472-480 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hinojosa Arco, Luis Carlos [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 19.07.2022 Date Revised 19.07.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.cireng.2022.05.015 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM341075302 |
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| 500 | |a Date Revised 19.07.2022 | ||
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 AEC. Published by Elsevier España, S.L.U. All rights reserved. | ||
| 520 | |a INTRODUCTION: Infectious complications play a prominent role in pancreaticoduodenectomy. Their incidence increases in cases with preoperative biliary drainage (PBD), due to the higher risk of bacterobilia. The aim of this study is to evaluate an antibiotherapy protocol based on intraoperative gram staining of bile and its impact on postoperative infectious complications | ||
| 520 | |a METHODS: A retrospective study analysing the incidence of infectious complications between two groups of 25 consecutive patients undergoing pancreaticoduodenectomy. In group 1, cefazolin prophylaxis was administered to patients without PBD. In cases with PBD a five days antibiotherapy with piperacillin-tazobactam was administered. In group 2, intraoperative gram staining of bile was routinely performed. If no microorganisms were detected, antibiotherapy was limited to cefazolin prophylaxis. If bacterobilia was detected, targeted antibiotherapy was administered for five days | ||
| 520 | |a RESULTS: The incidence of sepsis and organ/space infection in group 2 was 4% compared to 32% and 24% in group 1 respectively (p < 0.05). No differences were observed in the remaining morbimortality variables. The most prevalent microorganisms in bile were Enterococcus spp. and Klebsiella spp. In postoperative samples, they only appeared in 4% of cases in group 2 (p < 0.05), in favour of S. epidermidis, although they were also prevalent in group 1 (28 and 24% respectively) | ||
| 520 | |a CONCLUSION: Intraoperative gram staining of bile fluid could be a useful tool to conduct personalised antibiotic therapy in pancreaticoduodenectomy and contribute to the control of infectious complications | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Anti-bacterial agents | |
| 650 | 4 | |a Antibiotic prophylaxis | |
| 650 | 4 | |a Antibióticos | |
| 650 | 4 | |a Complicaciones postoperatorias | |
| 650 | 4 | |a Gram’s stain | |
| 650 | 4 | |a Pancreatectomy | |
| 650 | 4 | |a Pancreatectomía | |
| 650 | 4 | |a Postoperative complications | |
| 650 | 4 | |a Profilaxis antibiótica | |
| 650 | 4 | |a Tinción de gram | |
| 650 | 7 | |a Cefazolin |2 NLM | |
| 650 | 7 | |a IHS69L0Y4T |2 NLM | |
| 700 | 1 | |a Roldán de la Rua, Jorge Francisco |e verfasserin |4 aut | |
| 700 | 1 | |a Carranque Chaves, Gabriel Ángel |e verfasserin |4 aut | |
| 700 | 1 | |a Mora Navas, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a de Luna Díaz, Resi |e verfasserin |4 aut | |
| 700 | 1 | |a Suárez Muñoz, Miguel Ángel |e verfasserin |4 aut | |
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