Role of preoperative biliary stents, bile contamination and antibiotic prophylaxis in surgical site infections after pancreaticoduodenectomy.

Autor:	Gavazzi F; Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy. francesca.gavazzi@humanitas.it., Ridolfi C; Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy., Capretti G; Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy., Angiolini MR; Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy., Morelli P; Infectious Diseases Unit, Hospital Health Direction, Humanitas Research Hospital, Rozzano, Italy., Casari E; Microbiology Unit, Analysis Laboratory, Humanitas Research Hospital, Rozzano, Italy., Montorsi M; Chancellor of Humanitas University, Chief of Department of Surgery, Humanitas Research Hospital, Rozzano, Italy., Zerbi A; Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
Jazyk:	angličtina
Zdroj:	BMC gastroenterology [BMC Gastroenterol] 2016 Mar 31; Vol. 16, pp. 43. Date of Electronic Publication: 2016 Mar 31.
DOI:	10.1186/s12876-016-0460-1
Abstrakt:	Background: The routine use of preoperative biliary drainage before pancreaticoduodenectomy (PD) remains controversial. This observational retrospective study compared stented and non-stented patients undergoing PD to assess any differences in post-operative morbidity and mortality. Methods: A total of 180 consecutive patients who underwent PD and had intra-operative bile cultures performed between January 2010 and February 2013 were retrospectively identified. All patients received peri-operative intravenous antibiotic prophylaxis, primarily cefazolin. Results: Overall incidence of post-operative surgical complications was 52.3 %, with no difference between stented and non-stented patients (53.4 % vs. 51.1 %; p = 0.875). However, stented patients had a significantly higher incidence of deep incisional surgical site infections (SSIs) (p = 0.038). In multivariate analysis, biliary stenting was confirmed as a risk factor for deep incisional SSIs (p = 0.044). Significant associations were also observed for cardiac disease (p = 0.010) and BMI ≥25 kg/m(2) (p = 0.045). Enterococcus spp. were the most frequent bacterial isolates in bile (74.5 %) and in drain fluid (69.1 %). In antimicrobial susceptibilty testing, all Enterococci isolates were cefazolin-resistant. Conclusion: Given the increased risk of deep incisional SSIs, preoperative biliary stenting in patients underging PD should be used only in selected patients. In stented patients, an antibiotic with anti-enterococcal activity should be chosen for PD prophylaxis.
Databáze:	MEDLINE
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