Efficacy of Pre-Operative Antimicrobial Prophylaxis in Patients Undergoing Pancreatoduodenectomy: A Multi-Center Retrospective Analysis

Autor: Marloes A Smit, Jennifer M.J. Schreinemakers, Judith E. K. R. Hentzen, Gijs J. H. M. Ruijs, Marjan J. Bruins, Gijs A. Patijn, Coen G. Rupert
Rok vydání: 2018
Předmět:
Male
medicine.medical_treatment
Cefazolin
0302 clinical medicine
Klebsiella
Bile
Antibiotic prophylaxis
OUTCOMES
Middle Aged
Antimicrobial
Pancreaticoduodenectomy
Pre operative
OBSTRUCTIVE-JAUNDICE
Infectious Diseases
Treatment Outcome
HOSPITAL VOLUME
030220 oncology & carcinogenesis
CONSECUTIVE PATIENTS
030211 gastroenterology & hepatology
Female
medicine.drug
Microbiology (medical)
medicine.medical_specialty
bile cultures
PANCREATIC SURGERY
behavioral disciplines and activities
03 medical and health sciences
MORBIDITY
Metronidazole
medicine
Humans
Surgical Wound Infection
In patient
POSTOPERATIVE INFECTIOUS COMPLICATIONS
Aged
Retrospective Studies
BILIARY DRAINAGE
business.industry
MORTALITY
post-operative infectious complications
Streptococcus
Retrospective cohort study
Antibiotic Prophylaxis
Surgery
pre-operative biliary drainage
Gentamicins
business
Enterococcus
Zdroj: Surgical Infections, 19(6), 608-613. MARY ANN LIEBERT, INC
ISSN: 1557-8674
1096-2964
Popis: Background: The most common complications after pancreaticoduodenectomy (PD) are infectious, despite the standard use of cefazolin and metronidazole prophylaxis. Pre-operative biliary drainage (PBD) is a well-known risk factor for infectious complications. The objective was to identify the pathogens in intra-operative bile cultures in patients undergoing PDwith and without PBDto determine the optimal antimicrobial prophylaxis regimen. Patients and Methods: Patients who underwent PD between 2009 and 2016 were identified retrospectively in three major teaching hospitals in The Netherlands. Organisms isolated from intra-operative bile cultures were studied. If pathogen coverage by standard prophylaxis was incomplete, the most appropriate alternative regimen was determined. Results: Of this large cohort of 352 patients, 56% underwent PBD and 44% did not. Positive bile cultures were found in 87.9% in the PBD group, compared with 31.8% in the non-PBD group. The micro-organisms isolated most commonly were Enterococcus, Streptococcus, and Klebsiella species. Cefazolin and metronidazole were appropriate in only 71% of patients. Adding gentamicin would provide complete coverage in 99% of PBD and 100% of non-PBD patients. Conclusions: Our data confirm that PBD prior to PD leads to microbial colonization and antibiotic resistance. To potentially prevent infectious complications, gentamicin may be added to the standard antimicrobial prophylaxis.
Databáze: OpenAIRE
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