High incidence of postoperative infections after pancreaticoduodenectomy: A need for perioperative anti-infectious strategies - 04/02/21
, C. Delpierre a , R. Le Guern b, c , E. Kipnis a, b , G. Lebuffe a, d , X. Lenne e , F.-R. Pruvot f, g , S. Truant f, g , A. Bignon a , M. El Amrani f, g Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder
Highlights |
• | Documented or clinically suspected postoperative infections after cephalic pancreaticoduodenectomy occur in more than two thirds of patients and are associated with high antibiotic consumption. |
• | Documented postoperative infections in patients with bile colonization involve a microorganism isolated from the bile in 2/3 of cases and may be associated with a higher rate of severe complications. |
• | The most frequently isolated microorganisms in bile were Gram-negative bacilli (GNB) (57%) with a predominance of Escherichia coli and Klebsiella spp., followed by Gram-positive cocci (GPC) (43%) with a predominance of Enterococci and Streptococci. |
• | Bile colonization and postoperative infections with Enterococcus faecium and Candida spp. remain scarce. |
• | A short-term probabilistic perioperative antibiotic therapy adapted to the bile bacterial ecology rather than a surgical antibiotic prophylaxis may be prescribed to patients undergoing cephalic pancreaticoduodenectomy. This has to be evaluated in prospective, randomized, controlled trials. |
Abstract |
Objectives |
Postoperative infections occur frequently after pancreaticoduodenectomy, especially in patients with bile colonization. Recommendations for perioperative anti-infectious treatment are lacking, and clinical practice is heterogenous. We have analyzed the effects of bile colonization and antibiotic prophylaxis on postoperative infection rates, types and therapeutic consequences.
Methods |
Retrospective observational study in patients undergoing pancreaticoduodenectomy with intraoperative bile culture. Data on postoperative infections and non-infectious complications, bile cultures and antibiotic prophylaxis adequacy to biliary bacteria were collected.
Results |
Among 129 patients, 53% had a positive bile culture and 23% had received appropriate antibiotic prophylaxis. Postoperative documented infection rate was over 40% in patients with or without bile colonization, but antibiotic therapy was more frequent in positive bile culture patients (77% vs. 57%, P=0,008). The median duration of antibiotic therapy was 11 days and included a broad-spectrum molecule in 42% of cases. Two-thirds of documented postoperative infections involved one or more bacteria isolated in bile cultures, which was associated with a higher complication rate. While bile culture yielded Gram-negative bacilli (57%) and Gram-positive cocci (43%), fungal microorganisms were scarce. Adequate preoperative antibiotic prophylaxis according to bile culture was not associated with reduced infectious or non-infectious complication rates.
Conclusion |
Patients undergoing pancreaticoduodenectomy experience a high rate of postoperative infections, often involving bacteria from perioperative bile culture when positive, with no preventive effect of an adequate preoperative antibiotic prophylaxis. Increased postoperative complications in patients with bile colonization may render necessary a perioperative antibiotic treatment targeting bile microorganisms. Further prospective studies are needed to improve the anti-infectious strategy in these patients.
Le texte complet de cet article est disponible en PDF.Keywords : Perioperative infection, Surgical site infection, Cephalic pancreaticoduodenectomy, Antimicrobial prophylaxis, Bile colonization
Plan
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?