1
|
Ramírez-Arbeláez JA, Arroyave-Zuluaga RL, Barrera-Lozano LM, Hurtado V, González-Arroyave D, Ardila CM. Relationship between Intraoperative Bile Culture Outcomes and Subsequent Postoperative Infectious Complications: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2024; 2024:3930130. [PMID: 38803514 PMCID: PMC11129905 DOI: 10.1155/2024/3930130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/15/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024]
Abstract
The presence of positive bile culture during intraoperative procedures has been associated with elevated morbidity and mortality rates in hepatobiliopancreatic surgeries, contributing to increased healthcare expenditures. However, the precise impact of bactobilia on the development of postoperative complications remains uncertain due to existing disparities in the published literature. In this retrospective cohort study, we assessed 137 patients who underwent major hepatobiliopancreatic surgery to examine the relationship between intraoperative bile culture outcomes and subsequent postoperative infectious complications. Among patients with bactobilia, a significant 35.1% exhibited systemic or local infectious complications, whereas only 11.1% of those with negative culture results experienced any infectious complications (p = 0.002). Similarly, a notable difference was observed in the incidence of surgical site infections, with 24.3% in the bactobilia group compared to 7.9% in the negative culture group (p = 0.01). A total of 74 monomicrobial cultures with microbiological growth were isolated, predominantly featuring Gram-negative microorganisms, primarily Enterobacteriaceae in 49 cultures. Escherichia coli was identified in 37.8% of positive cultures, while Klebsiella pneumoniae was evident in 21.6%. Gram-positive microorganisms were present in 10 cultures, with Enterococcus emerging as the prevailing species. The logistic regression model identified a positive bile culture as an independent factor significantly associated with infection development (OR: 2.26; 95% confidence interval: 1.23-11; p = 0.02). Considering the limitations of the study, these findings underscore the critical importance of conducting bile cultures during the intraoperative phase to enable vigilant monitoring and prompt management of infectious complications.
Collapse
Affiliation(s)
| | | | - Luis Manuel Barrera-Lozano
- Department of Transplants, Hospital San Vicente Fundación, Rionegro, Colombia
- Department of General Surgery, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Verónica Hurtado
- Department of Transplants, Hospital San Vicente Fundación, Rionegro, Colombia
| | | | | |
Collapse
|
2
|
Vierra M, Rouhani Ravari M, Soleymani Sardoo F, Shogan BD. Tailored Pre-Operative Antibiotic Prophylaxis to Prevent Post-Operative Surgical Site Infections in General Surgery. Antibiotics (Basel) 2024; 13:99. [PMID: 38275328 PMCID: PMC10812803 DOI: 10.3390/antibiotics13010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
The average American today undergoes three inpatient and two outpatient surgical procedures during one's life, each of which carries with it a risk of post-operative infection. It has long been known that post-operative infections cause significant morbidity in the immediate peri-operative period, but recent evidence suggests that they can have long-term consequences as well, increasing a patient's risk of infectious complications in unrelated surgeries performed months or even years later. While there are several theories on the origin of this association, including bacterial colonization of a post-operative infectious wound site, antimicrobial resistance from curative courses of antibiotics, subclinical immunosuppression, or the creation of an inflammatory "pathobiome" following an infectious insult, it is ultimately still unclear why patients who experience a single post-operative infection seem to be at a significantly higher risk of experiencing subsequent ones. Regardless, this association has significant implications for the routine use of pre-operative antibiotic prophylaxis. Indeed, while the prescription of antibiotics pre-operatively has dramatically reduced the rate of post-operative infections, the chosen prophylaxis regimens are typically standardized according to national guidelines, are facing increasing antimicrobial resistance patterns, and have been unable to reduce the risk of post-operative infection to acceptably low levels for certain surgeries. As a result, some clinicians have speculated that tailoring pre-operative antibiotic prophylaxis according to a patient's prior infectious and operative history could improve efficacy and further reduce the rate of post-operative infections. The purpose of this review is to describe the evidence for the link between multiple post-operative infections and explore the efficacy of individualized pre-operative prophylaxis.
Collapse
Affiliation(s)
- Mason Vierra
- Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637, USA;
| | - Mohsen Rouhani Ravari
- Department of Surgery, The University of Chicago Medicine, Chicago, IL 60637, USA; (M.R.R.); (F.S.S.)
| | - Fatemeh Soleymani Sardoo
- Department of Surgery, The University of Chicago Medicine, Chicago, IL 60637, USA; (M.R.R.); (F.S.S.)
| | - Benjamin D. Shogan
- Department of Surgery, The University of Chicago Medicine, Chicago, IL 60637, USA; (M.R.R.); (F.S.S.)
| |
Collapse
|
3
|
Ongen G, Nas OF, Hacikurt K, Dundar HZ, Ozkaya G, Kaya E, Hakyemez B. Internal versus external biliary drainage in malignant biliary obstructions: is there a difference in the rate of infection? Acta Radiol 2023; 64:2501-2505. [PMID: 37611191 DOI: 10.1177/02841851231187078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Percutaneous biliary drainage is a frequently used method to provide biliary decompression in patients with biliary obstruction. PURPOSE To investigate the between drainage type and infection risk in patients treated with internal-external and external biliary drainage catheterization for malignant biliary obstruction. MATERIAL AND METHODS A total of 410 patients with malignant biliary obstruction who underwent internal-external or external biliary drainage catheterization between January 2012 and October 2016 were retrospectively evaluated. We investigated the correlation between percutaneous biliary drainage technique and infection frequency by evaluating patients with clinical findings, bile and blood cultures, complete blood counts, and blood biochemistry. RESULTS There was no statistically significant difference between the selected patient groups (internal-external or external biliary drainage catheter placed) in terms of age, sex, primary diagnosis, receiving chemotherapy, catheter sizes, and outpatient-patient status. After catheterization, catheter-related infection was observed in 49 of 216 (22.7%) patients with internal-external and 18 of 127 (14.2%) patients with external biliary drainage catheters, according to the defined criteria. There was no difference in infection rate after the biliary drainage in the two groups (P > 0.05). There was also no difference concerning frequently proliferating microorganisms in bile cultures. CONCLUSION Internal-external biliary drainage catheter placement does not bring an additional infection risk for uninfected cholestatic patients whose obstruction could be passed easily in the initial drainage.
Collapse
Affiliation(s)
- Gokhan Ongen
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| | - Omer Fatih Nas
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| | - Kadir Hacikurt
- Department of Radiology, Eastbourne District General Hospital, East Sussex, England
| | - Halit Ziya Dundar
- Department of General Surgery, Bursa Medicana Hospital, Bursa, Turkey
| | - Guven Ozkaya
- School of Medicine, Department of Biostatistics, Bursa Uludag University, Bursa, Turkey
| | - Ekrem Kaya
- School of Medicine, Department of General Surgery, Bursa Uludag University, Bursa, Turkey
| | - Bahattin Hakyemez
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| |
Collapse
|
4
|
Behrens S, Sutton TL, Patel R, Schwantes IR, O'Grady J, Johnson A, Grossberg A, Lopez C, Gilbert E, Mayo S, Sheppard BC. Neoadjuvant therapy does not impact the biliary microbiome in patients with pancreatic cancer. J Surg Oncol 2023; 128:271-279. [PMID: 37095724 DOI: 10.1002/jso.27281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Pancreatic adenocarcinoma (PDAC) often impinges on the biliary tree and obstruction necessitates stent placement increasing the risk of surgical site infections (SSIs). We sought to explore the impact of neoadjuvant therapy on the biliary microbiome and SSI risk in patients undergoing resection. METHODS A retrospective analysis was performed on 346 patients with PDAC who underwent resection at our institution from 2008 to 2021. Univariate and multivariate methods were utilized for analysis. RESULTS Biliary stenting rates were similar between groups but resulted in increased bile culture positivity (97% vs. 15%, p < 0.001). Culture positivity did not differ between upfront resection or neoadjuvant chemotherapy (NAC) (77% vs. 80%, p = 0.60). NAC-alone versus neoadjuvant chemoradiotherapy did not impact biliary positivity (80% vs. 79%, p = 0.91), nor did 5-fluorouracil versus gemcitabine-based regimens (73% vs. 85%, p = 0.19). While biliary stenting increased incisional SSI risk (odds ratios [OR]: 3.87, p = 0.001), NAC did not (OR: 0.83, p = 0.54). Upfront resection, NAC, and chemoradiotherapy were not associated with biliary organism-specific changes or antibiotic resistance patterns. CONCLUSIONS Biliary stenting is the greatest predictor for positive biliary cultures and SSIs in resected PDAC patients. Neither NAC nor radiotherapy impact bile culture positivity, speciation, rates, or antibiotic resistance patterns, and perioperative antibiotic prophylaxis should not differ.
Collapse
Affiliation(s)
- Shay Behrens
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Thomas L Sutton
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Ranish Patel
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Issac R Schwantes
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | | | - Alicia Johnson
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Aaron Grossberg
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Charles Lopez
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Erin Gilbert
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| | - Skye Mayo
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
- Department of Surgery, Division of Surgical Oncology, OHSU, Portland, Oregon, USA
| | - Brett C Sheppard
- Department of Surgery, Oregon Heath & Science University (OHSU), Portland, Oregon, USA
| |
Collapse
|
5
|
Svatoň R, Procházka V, Hanslianová M, Kala Z. Influence of bacteriobilia on postoperative complications in patients with periampullary tumors. Asian J Surg 2023; 46:1193-1198. [PMID: 36057492 DOI: 10.1016/j.asjsur.2022.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/21/2021] [Accepted: 08/17/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Periampullary tumours (PAT) may cause obstruction of distal choledochus. The bile stasis is a risk factor for microbial colonisation of bile (bacteriobilia), cholangitis, hepatic insufficiency and coagulopathy. PAT obstruction can be managed surgically or non-operatively - by inserting a biliary drain or stent (BDS). Although BDS allows for adequate bile drainage, liver function restitution and coagulopathy, increased bacteriobilia has been reported and this is associated with an increased incidence of postoperative complications. METHODS A monocentric, prospective, comparative study including 100 patients operated with PAT. The effects of bacteriobilia and the presence of a drain in the biliary tract on the development of postoperative complications were evaluated. RESULTS Positive microbial findings in bile were found in 67% of patients. It was 98% in the biliary drain group vs. 36% in non-drained patients (p = 0.0001). In 68% 2 or more different bacterial strains were simultaneously present (p = 0.0001). Patients with a positive microbial finding in bile had more frequent incidence of infectious complications 40.2% (27) vs. 9.1% (3); p = 0.0011. The most frequent infectious complication was wound infection 29.8% (20) vs. 3.03% (1); p = 0.0014. Similarly, a higher incidence of postoperative infectious complications occurred in patients with BDS - 36% (18) vs. 24% (12); p = 0.2752. CONCLUSION The presence of a drain or stent in the biliary tract significantly increases the microbial colonisation of bile. It is associated with a significant increase in infectious complications, especially infections in the wound.
Collapse
Affiliation(s)
- Roman Svatoň
- Department of Surgery, University Hospital Brno Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Vladimír Procházka
- Department of Surgery, University Hospital Brno Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Markéta Hanslianová
- Department of Microbiology, University Hospital Brno Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Zdeněk Kala
- Department of Surgery, University Hospital Brno Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| |
Collapse
|
6
|
Kar M, Dubey A, Patel SS, Sahu C, Yadav A. Multifactorial Analysis of Biliary Infection in Patients with Hepato-pancreatico-biliary and Associated Intraabdominal Malignancies Admitted to a Teaching Hospital in Northern India. Euroasian J Hepatogastroenterol 2023; 13:10-17. [PMID: 37554979 PMCID: PMC10405806 DOI: 10.5005/jp-journals-10018-1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/23/2023] [Indexed: 08/10/2023] Open
Abstract
Background Blockage of the biliary tract is commonly caused by malignant tumors leading to deranged liver function, responsible for poor prognosis and a high rate of bacteriobilia leading to mortality. Material and methods We collected retrospective data from the hospital information system and laboratory registers in our department from 2021 to 2022 to evaluate biliary infections in patients with hepato-pancreatico-biliary and associated intraabdominal malignancies. Result A total of 118 (118/234, 50.43%) patients' bile samples were estimated in this study. Patients' average age was 53.02 ± 13.49 years, with more patients below the age of 65 years among those with infected bile samples. Eight patients were infected by 102 pathogenic microorganisms. The most common pathogenic microorganism responsible for biliary infection in patients with abdominal malignancies was Escherichia coli (38/102, 37.25%) followed by Klebsiella pneumoniae (21/102, 20.59%) and Enterococcus spp. (18/102, 17.65%). Underlying comorbidities like diabetes mellitus, hypothyroidism, hypoproteinemia, chronic liver disease, immunosuppression, chronic kidney disease, increased hospital stay, admission to the intensive care unit (ICU), and presence of percutaneous transhepatic biliary drain were statistically significant risk factors for isolation of multidrug-resistant pathogenic bacteria. Conclusion Our study guided physicians in identifying the associated demographic characteristics, risk factors, and the spectrum of pathogens responsible for bacteriobilia in abdominal cancer patients along with the antibiotic resistance pattern among these isolates and better selection of antibiotics and antibiotic prophylaxis for patients at risk of developing biliary tract infections with multidrug-resistant pathogens. How to cite this article Kar M, Dubey A, Patel SS, et al. Multifactorial Analysis of Biliary Infection in Patients with Hepato-pancreatico-biliary and Associated Intraabdominal Malignancies Admitted to a Teaching Hospital in Northern India. Euroasian J Hepato-Gastroenterol 2023;13(1):10-17.
Collapse
Affiliation(s)
- Mitra Kar
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Akanksha Dubey
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sangram Singh Patel
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Chinmoy Sahu
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anjali Yadav
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
7
|
Araz H, Eren T, Kocagül-Çelikbaş A, Özdemir N. Evaluation of Blood Stream and Biliary Tract Infections Related to Percutaneous Transhepatic Cholangiography and Prophylaxis Given in Patients with Malignancy. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:274-279. [PMID: 38633711 PMCID: PMC10986684 DOI: 10.36519/idcm.2022.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/22/2022] [Indexed: 04/19/2024]
Abstract
Objective Percutaneous transhepatic cholangiography (PTC) is an invasive procedure used in patients with obstructive jaundice in the progress of some malignancies, and its most common complication is infection. We aimed to evaluate the patients who underwent PTC regarding their cultures, prophylaxis, and antibiotics used for treatment. Materials and Methods In this cross-sectional study, patients who underwent PTC and were followed up in a medical oncology outpatient clinic between 2010-2017 were evaluated retrospectively. Patients' data were obtained from the hospital record system (FONET), epicrisis forms, and patient progress files. Results A total of 93 patients were included in the study. Prophylaxis was given in 50% of the cases. Complications developed in 68% of the cases after the intervention, and the infectious disease clinic consulted all. Blood cultures were obtained from 89% of the febrile patients; however, bile cultures were obtained only from 29%. The rate of resistant Gram-negative enteric bacteria in growing microorganisms was 52% (n=13). It was determined that 65% of the initiated empirical treatments were appropriate for the growth of microorganisms. Conclusion The growth rate was significantly higher in blood cultures than in bile cultures. The lower growth rate in bile culture was attributed to the low number of bile cultures. There was no significant difference regarding the growth rate and drug resistance of the microorganisms. Therefore, we think giving antibiotics as treatment rather than prophylaxis is more appropriate. Taking cultures will ensure that patients receive appropriate antibiotic therapy for the causative agent.
Collapse
Affiliation(s)
- Halime Araz
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Tülay Eren
- Department of Medical Oncology, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara
| | - Aysel Kocagül-Çelikbaş
- Department of Infectious Diseases and Clinical Microbiology, Hitit University School of Medicine, Çorum, Turkey
| | - Nuriye Özdemir
- Department of Medical Oncology, Gazi University School of Medicine, Ankara, Turkey
| |
Collapse
|
8
|
Khurana N, Salei A, Gunn AJ, Huang J. Antibiotics Tubes and Lines. Semin Intervent Radiol 2022; 39:421-427. [PMID: 36406021 PMCID: PMC9671683 DOI: 10.1055/s-0042-1758080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Antibiotic prophylaxis in interventional radiology (IR) is widely used; however, such practice is based on data from the surgical literature. Although published guidelines can help determine the need for prophylactic antibiotic use in the patient undergoing percutaneous procedures, local practice patterns often dictate when such medications are given. In this article, the current state of periprocedural antibiotic use in commonly performed IR procedures (i.e., tube and catheter placements) is presented.
Collapse
Affiliation(s)
- Navpreet Khurana
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aliaksei Salei
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew J. Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Junjian Huang
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
9
|
Intraoperative Bile Culture in Pancreaticoduodenectomy: Teaching Old Dogma New Tricks. J Gastrointest Surg 2022; 26:30-38. [PMID: 34704185 DOI: 10.1007/s11605-021-05182-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Biliary stents increase surgical site infections (SSIs) following pancreaticoduodenectomy due to bactibilia and contaminated intraoperative bile spillage. Intraoperative bile culture (IOBC) is performed to guide empiric therapy for SSIs; however, its utility is poorly studied. We sought to evaluate IOBC and the interplay between stenting, bactibilia, and SSI following pancreaticoduodenectomy. METHODS Patients undergoing pancreaticoduodenectomy from January 2008 to April 2020 were identified through our institutional National Surgical Quality Improvement Project (NSQIP) database; patients without IOBC were excluded. Odds of SSI were analyzed with multivariable logistic regression. RESULTS Four-hundred-eighty-three patients were identified. One-hundred-eighty-nine (39%) patients had plastic stents and 154 (32%) had metal stents. Three-hundred-twenty-nine (96%) patients with stents had bactibilia versus 18 (13%) without stents (P < 0.001). The biliary microbiome and antibiotic resistance patterns in patients with metal and plastic stents were nearly identical. Of 159 NSQIP-defined SSIs, most were incisional (n = 92, 58%). Bactibilia and stent presence were associated with incisional (OR 3.69 and 3.39, both P < 0.001) but not organ space SSI (P > 0.1); however, stent type was not (P > 0.5). Of the 73 speciated SSI cultures, an IOBC-identified organism was present in 42 (58%), while at least one organism not found in the IOBC was present in 49 (67%). CONCLUSION Bactibilia is associated with incisional but not organ space SSI following pancreaticoduodenectomy and is strongly associated with stent presence. Stent type does not independently influence the biliary microbiome or SSI risk. IOBC has a poor ability to predict causative organisms in SSIs following pancreaticoduodenectomy and is not recommended for routine use.
Collapse
|
10
|
Darnell EP, Wang TJ, Lumish MA, Hernandez-Barco YG, Weniger M, Casey BW, Qadan M, Lillemoe KD, Ferrone CR, Fernandez-Del Castillo C, Krishnan K. Preoperative cholangitis is an independent risk factor for mortality in patients after pancreatoduodenectomy for pancreatic cancer. Am J Surg 2020; 221:134-140. [PMID: 32847686 DOI: 10.1016/j.amjsurg.2020.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/31/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Preoperative biliary stenting is required for patients with obstructive jaundice from pancreatic adenocarcinoma who are receiving neoadjuvant chemotherapy. While in most patients this approach results in durable biliary drainage, some patients develop cholangitis during neoadjuvant treatment. Further, several studies have shown that preoperative cholangitis in patients with hepatobiliary malignancies can result in substantially unfavorable outcomes. The aim of this study was to evaluate the impact of preoperative cholangitis in patients who underwent pancreaticoduodenectomy after completing neoadjuvant chemotherapy. METHODS Participants: all adult patients (n = 449) diagnosed with pancreatic adenocarcinoma from January 1st, 2013 to March 31st, 2018 who pursued treatment at the Massachusetts General Hospital were screened. Of these 449 patients, 97 met final inclusion criteria of receiving neoadjuvant chemotherapy with intent to pursue curative surgery. Data were collected via retrospective chart review including baseline characteristics, survival, episodes of preoperative cholangitis, and surgical complications. RESULTS In patients completing successful pancreaticoduodenectomy surgery, preoperative cholangitis is associated with increased mortality (HR 2.67, 95% CI:1.16-6.13). This finding is independent of postoperative outcomes or tumor recurrence rate. The presence of cholangitis did not impact completion of neoadjuvant chemotherapy (92% vs 85%, p = 0.5) or ability to proceed to surgery (76% vs 75%, p = 1.0). Preoperative cholangitis was not associated with postoperative morbidity (42.1% vs 45.1%, p = 1.0). CONCLUSIONS One episode of cholangitis during neoadjuvant chemotherapy is associated with increased mortality following successful pancreaticoduodenectomy, independent of immediate postoperative outcomes or tumor recurrence. Preoperative cholangitis does not affect ability to pursue neoadjuvant chemotherapy or complete successful surgery. Patients who develop cholangitis during the neoadjuvant chemotherapy treatment phase may reflect a distinct phenotype of patients with PDAC with a complex and more challenging clinical course.
Collapse
Affiliation(s)
- Eli P Darnell
- Massachusetts General Hospital, Department of Medicine, United States
| | - Thomas J Wang
- Massachusetts General Hospital, Department of Medicine, United States
| | - Melissa A Lumish
- Memorial Sloan Kettering, Department of Medicine, Division of Hematology Oncology, United States
| | - Yasmin G Hernandez-Barco
- Massachusetts General Hospital, Department of Medicine, Division of Gastroenterology, United States
| | | | - Brenna W Casey
- Massachusetts General Hospital, Department of Medicine, Division of Gastroenterology, United States
| | - Motaz Qadan
- Massachusetts General Hospital, Department of Surgery, United States
| | - Keith D Lillemoe
- Massachusetts General Hospital, Department of Surgery, United States
| | | | | | - Kumar Krishnan
- Massachusetts General Hospital, Department of Medicine, Division of Gastroenterology, United States.
| |
Collapse
|
11
|
Kumagai YU, Fujioka S, Hata T, Misawa T, Kitamura H, Furukawa K, Ishida Y, Yanaga K. Impact of Bile Exposure Time on Organ/space Surgical Site Infections After Pancreaticoduodenectomy. In Vivo 2019; 33:1553-1557. [PMID: 31471404 DOI: 10.21873/invivo.11636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/28/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM Organ/space surgical site infections (SSIs) are critical complications of pancreaticoduodenectomy. We investigated the impact of the time between division of the common hepatic duct and completion of biliary reconstruction [bile exposure (BE) time] on the occurrence of post-pancreaticoduodenectomy organ/space SSI. PATIENTS AND METHODS Sixty-one patients who underwent pancreaticoduodenectomy were retrospectively studied. The impact of perioperative variables and BE time on organ/space SSI occurrence was analyzed. RESULTS Organ/space SSIs occurred in 17 patients (28%). Patients were divided into two groups according to BE time. The incidence of organ/space SSIs was significantly higher in the long BE time group than in the short BE time group (42% versus 13%, p=0.0127). Multivariate analysis revealed that long BE times [odds ratio (OR)=4.8; p=0.0240] and soft pancreatic texture (OR=16.5; p=0.0106) were independent risk factors for organ/space SSIs. CONCLUSION Long BE time is a risk factor for post-pancreaticoduodenectomy organ/space SSIs. Shortening BE time may reduce organ/space SSI occurrence.
Collapse
Affiliation(s)
- Y U Kumagai
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Shuichi Fujioka
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Taigo Hata
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takeyuki Misawa
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroaki Kitamura
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Kenei Furukawa
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuichi Ishida
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
12
|
Degrandi O, Buscail E, Martellotto S, Gronnier C, Collet D, Adam JP, Ouattara A, Laurent C, Dewitte A, Chiche L. Perioperative antibiotherapy should replace prophylactic antibiotics in patients undergoing pancreaticoduodenectomy preceded by preoperative biliary drainage. J Surg Oncol 2019; 120:639-645. [PMID: 31297827 DOI: 10.1002/jso.25622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/23/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Pancreaticoduodenectomy (PD) remains a morbid surgery. Preoperative biliary drainage (PBD) is often necessary before surgery but is associated with biliary contamination. We compared the postoperative complications of patients undergoing PBD who received the usual prophylactic antibiotics (PAs) or systematic antibiotherapy (ABT). METHODS All patients who underwent surgery between 2008 and 2017 were included. Systematic perioperative ABT with piperacillin + tazobactam (ABT group) was implemented in 2014 as the standard of care for PBD. Patients treated in the period before such implementation, during which standard cefazolin was given, served as the controls (PAs group). The primary outcomes were postoperative complications. RESULTS We included 122 patients with PBD who underwent surgery. There were no demographic differences between the two groups. Perioperative ABT was associated with a reduction in deep abdominal abscesses (36% vs 10%, P = .0008), respiratory tract infections (15% vs 3%; P = .02), bacteremia (41% vs 6%; P < .0001), and a shorter length of hospital stay (17 [13-27] vs 13 [10-14] days; P < .0001). ABT was a protective factor against the development of deep abdominal abscesses (odds ratio [OR] = 0.16; P = .001) whereas smoking (OR = 3.9) and pancreatic fistula (OR = 19.1) were risk factors. CONCLUSION Systematic perioperative ABT in patients undergoing PD preceded by PBD may reduce deep surgical infections and the length of hospital stay.
Collapse
Affiliation(s)
- O Degrandi
- Department of Digestive And Endocrinology Surgery, Centre for Digestive System Diseases, Magellan, University Hospital of Bordeaux, Pessac, France.,Department of tissus engineering, INSERM UMR 1026, University of Bordeaux, Bordeaux, France.,Department of Research, INSERM UMR 1035, University of Bordeaux, Bordeaux, France
| | - E Buscail
- Department of Digestive And Endocrinology Surgery, Centre for Digestive System Diseases, Magellan, University Hospital of Bordeaux, Pessac, France.,Department of Research, INSERM UMR 1035, University of Bordeaux, Bordeaux, France
| | - S Martellotto
- Department of Digestive And Endocrinology Surgery, Centre for Digestive System Diseases, Magellan, University Hospital of Bordeaux, Pessac, France
| | - C Gronnier
- Department of Digestive And Endocrinology Surgery, Centre for Digestive System Diseases, Magellan, University Hospital of Bordeaux, Pessac, France.,Department of tissus engineering, INSERM UMR 1026, University of Bordeaux, Bordeaux, France
| | - D Collet
- Department of Digestive And Endocrinology Surgery, Centre for Digestive System Diseases, Magellan, University Hospital of Bordeaux, Pessac, France.,Department of tissus engineering, INSERM UMR 1026, University of Bordeaux, Bordeaux, France
| | - J P Adam
- Department of Digestive And Endocrinology Surgery, Centre for Digestive System Diseases, Magellan, University Hospital of Bordeaux, Pessac, France
| | - A Ouattara
- Department of Biology of Cardiovascular Diseases, INSERM UMR 1034, University of Bordeaux, Pessac, France.,Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Center, CHU Bordeaux, Bordeaux, France
| | - C Laurent
- Department of Digestive And Endocrinology Surgery, Centre for Digestive System Diseases, Magellan, University Hospital of Bordeaux, Pessac, France.,Department of Research, INSERM UMR 1035, University of Bordeaux, Bordeaux, France
| | - A Dewitte
- Department of Biology of Cardiovascular Diseases, INSERM UMR 1034, University of Bordeaux, Pessac, France.,Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Center, CHU Bordeaux, Bordeaux, France
| | - L Chiche
- Department of Digestive And Endocrinology Surgery, Centre for Digestive System Diseases, Magellan, University Hospital of Bordeaux, Pessac, France.,Department of Research, INSERM UMR 1035, University of Bordeaux, Bordeaux, France
| |
Collapse
|
13
|
Di Carlo P, Serra N, D'Arpa F, Agrusa A, Gulotta G, Fasciana T, Rodolico V, Giammanco A, Sergi C. The microbiota of the bilio-pancreatic system: a cohort, STROBE-compliant study. Infect Drug Resist 2019; 12:1513-1527. [PMID: 31354308 PMCID: PMC6578573 DOI: 10.2147/idr.s200378] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/13/2019] [Indexed: 12/11/2022] Open
Abstract
Background: The gut microbiota play an essential role in protecting the host against pathogenic microorganisms by modulating immunity and regulating metabolic processes. In response to environmental factors, microbes can hugely alter their metabolism. These factors can substantially impact the host and have potential pathologic implications. Particularly pathogenic microorganisms colonizing pancreas and biliary tract tissues may be involved in chronic inflammation and cancer evolution. Purpose: To evaluate the effect of bile microbiota on survival in patients with pancreas and biliary tract disease (PBD). Patients and Methods: We investigated 152 Italian patients with cholelithiasis (CHL), cholangitis (CHA), cholangiocarcinoma (CCA), gallbladder carcinoma (GBC), pancreas head carcinoma (PHC), ampullary carcinoma (ACA), and chronic pancreatitis (CHP). Demographics, bile cultures, therapy, and survival rates were analyzed in cohorts (T1 death <6 months; T2 death <12 months; T3 death <18 months, T3S alive at 18 months). Results: The most common bacteria in T1 were E. coli, K. pneumoniae, and P. aeruginosa. In T2, the most common bacteria were E. coli and P. aeruginosa. In T3, there were no significant bacteria isolated, while in T3S the most common bacteria were like those found in T1. E. coli and K. pneumoniae were positive predictors of survival for PHC and ACA, respectively. E. coli, K. pneumoniae, and P. aeruginosa showed a high percentage of resistant bacteria to 3CGS, aminoglycosides class, and quinolone group especially at T1 and T2 in cancer patients. Conclusions: An unprecedented increase of E. coli in bile leads to a decrease in survival. We suggest that some strains isolated in bile samples may be considered within the group of risk factors in carcinogenesis and/or progression of hepato-biliary malignancy. A better understanding of bile microbiota in patients with PBD should lead to a multifaceted approach to rapidly detect and treat pathogens before patients enter the surgical setting in tandem with the implementation of the infection control policy.
Collapse
Affiliation(s)
- Paola Di Carlo
- Department of Sciences for Health Promotion, Mother & Child Care, University of Palermo, Palermo, Italy
| | - Nicola Serra
- Statistic Unit, Department of Public Health, University of Naples 'Federico II', Naples, Italy
| | - Francesco D'Arpa
- Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Antonino Agrusa
- Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Gaspare Gulotta
- Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Teresa Fasciana
- Department of Sciences for Health Promotion, Mother & Child Care, University of Palermo, Palermo, Italy
| | - Vito Rodolico
- Department of Sciences for Health Promotion, Mother & Child Care, University of Palermo, Palermo, Italy
| | - Anna Giammanco
- Department of Sciences for Health Promotion, Mother & Child Care, University of Palermo, Palermo, Italy
| | - Consolato Sergi
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.,Department of Laboratory Medicine and Pathology, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
14
|
Takahashi Y, Takesue Y, Fujiwara M, Tatsumi S, Ichiki K, Fujimoto J, Kimura T. Risk factors for surgical site infection after major hepatobiliary and pancreatic surgery. J Infect Chemother 2018; 24:739-743. [PMID: 30001844 DOI: 10.1016/j.jiac.2018.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/21/2018] [Accepted: 05/20/2018] [Indexed: 02/07/2023]
Abstract
Major hepatobiliary and pancreatic (HP) surgeries are complex procedures associated with a high incidence of surgical site infection (SSI) and are commonly performed in patients with cancer in Japan. This study was performed to investigate the risk factors for SSI, including incisional and organ/space SSI, in HP surgery. The following procedures were included in the study: hepatectomy with and without biliary tract resection, pancreatectomy [pancreaticoduodenectomy (PD), others], and open cholecystectomy. In total, 735 patients were analyzed. The incidence of SSI was 17.8% (incisional, 5.2%; organ/space, 15.5%; both 2.9%). The highest incidence of SSI was observed in patients who underwent hepatectomy with biliary tract resection (39.1%), followed by pancreatectomy (PD, 28.8%; others, 29.8%). Almost all SSIs after these three procedures were classified as organ/space (39.1%, 25.0%, and 27.7%, respectively), and these procedures were risk factors for not only total SSI but also organ/space SSI in the multivariate analysis. An American Society of Anesthesiologists physical status of ≥3 was a risk factor for incisional SSI. Preoperative biliary drainage, prolonged surgery, concomitant surgery, and massive intraoperative bleeding were associated with SSI. In conclusion, the main type of SSI was organ/space SSI after HP surgery, and different risk factors were identified between organ/space and incisional SSI. Procedure-related factors and preoperative biliary drainage were independent risk factors for SSI. To prevent SSI, the indication for preoperative biliary drainage should be carefully evaluated in patients undergoing HP surgery.
Collapse
Affiliation(s)
- Yoshiko Takahashi
- Department of Pharmacy, Hospital of Hyogo College of Medicine, Hyogo, Japan.
| | - Yoshio Takesue
- Department of Infection Prevention and Control, Hyogo College of Medicine, Hyogo, Japan
| | | | - Sumiyo Tatsumi
- Department of Pharmacy, Hospital of Hyogo College of Medicine, Hyogo, Japan
| | - Kaoru Ichiki
- Department of Infection Prevention and Control, Hyogo College of Medicine, Hyogo, Japan
| | - Jiro Fujimoto
- Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Takeshi Kimura
- Department of Pharmacy, Hospital of Hyogo College of Medicine, Hyogo, Japan
| |
Collapse
|
15
|
Duan F, Cui L, Bai Y, Li X, Yan J, Liu X. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging 2017; 17:27. [PMID: 29037223 PMCID: PMC5644169 DOI: 10.1186/s40644-017-0129-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/06/2017] [Indexed: 12/16/2022] Open
Abstract
Background Malignant obstructive jaundice is a common problem in the clinic. Currently, the generally applied treatment methods are percutaneous transhepatic biliary drainage (PTBD) and endoscopic biliary drainage (EBD). Nevertheless, there has not been a uniform conclusion published on either efficacy of the two types of drainage or the incidence rate of complications. Therefore, we conducted a systematic review and meta-analysis of studies comparing endoscopic versus percutaneous biliary drainage in malignant obstructive jaundice, to determine whether there is any difference between percutaneous and endoscopic biliary drainage, with respect to efficacy and incidence rate of overall complications. Methods The enrolled studies contain a total of three randomized controlled trials and eleven retrospective studies, which together encompass 2246 patients with PTBD and 8100 patients with EBD. Results Our analysis indicates that there is no difference between PTBD and EBD with regard to therapeutic success rate (%), overall complication (%), intraperitoneal bile leak, 30-day mortality, sepsis, or duodenal perforation (%). Cholangitis and pancreatitis after PTBD were lower than after EBD, with odds ratios (OR) of 0.48 (95% confidence interval (CI), 0.31 to 0.74) and 0.16 (95% CI, 0.05 to 0.52), respectively. Incidences of bleeding and tube dislocation for PTBD were higher than EBD, OR of 1.81 (95% CI, 1.35 to 2.44) and 3.41 (95% CI, 1.10 to 10.60). Conclusions This meta-analysis indicates certain advantages for both PTBD and EBD. In the clinical practice, it is advised to choose specifically either PTBD or EBD, based on location of obstruction, purpose of drainage (as a preoperative procedure or a palliative treatment) and level of experience in biliary drainage at individual treatment centers.
Collapse
Affiliation(s)
- Feng Duan
- Department of Interventional Radiology, the General Hospital of Chinese People's Liberation Army, Beijing, 100853, China.
| | - Li Cui
- Department of Interventional Radiology, the General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Yanhua Bai
- Department of Interventional Radiology, the General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Xiaohui Li
- Department of Interventional Radiology, the General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Jieyu Yan
- Department of Interventional Radiology, the General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Xuan Liu
- Department of Interventional Radiology, the General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| |
Collapse
|
16
|
Preoperative biliary drainage in hilar cholangiocarcinoma: Systematic review and meta-analysis. Eur J Surg Oncol 2017; 43:1628-1635. [PMID: 28477976 DOI: 10.1016/j.ejso.2017.04.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/14/2017] [Accepted: 04/04/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The role of preoperative biliary drainage (PBD) for hilar cholangiocarcinoma (HCC) remains unclear. The aim of this meta-analysis is to investigate the role of PBD in the treatment of potentially resectable HCC. METHODS All studies reporting outcomes on patients with PBD vs without PBD were included. A systematic literature search was performed in PubMed, Embase, and the Cochrane Library for studies published between 1980 and 2016. RESULTS Initial search identified 667 articles. Only 9 studies met the inclusion criteria and were included in this analysis. No significant differences in mortality were observed between the two groups (RR = 0,935; 95% CI = 0,612 to 1429; p = 0,463). Overall morbidity was significantly higher in PBD group (RR = 1266; 95% CI = 1039 to 1543; p = 0,011). No significant differences in transfusion rate, hospital stay, anastomotic leaks, abdominal collections and operative time, were found. Wound infections were significantly higher in PBD group. CONCLUSIONS PBD seems to be associated with higher postoperative morbidity and increases the risk of wound infections. Further prospective studies are needed to better define the impact of PBD in outcomes after surgery for hilar cholangiocarcinoma.
Collapse
|
17
|
Scheufele F, Aichinger L, Jäger C, Demir IE, Schorn S, Sargut M, Erkan M, Kleeff J, Friess H, Ceyhan GO. Effect of preoperative biliary drainage on bacterial flora in bile of patients with periampullary cancer. Br J Surg 2017; 104:e182-e188. [PMID: 28121036 DOI: 10.1002/bjs.10450] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/27/2016] [Accepted: 11/03/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with obstructive jaundice due to periampullary tumours may undergo preoperative biliary drainage (PBD). The effect of PBD on the microbiome of the biliary system and on postoperative outcome remains unclear. METHODS A single-centre retrospective study of patients with obstructive jaundice due to periampullary cancer, treated between July 2007 and July 2015, was undertaken. Intraoperative bile samples were obtained for microbiological analysis after transection of the common bile duct. Postoperative complications were registered. RESULTS Of 290 patients treated, intraoperative bile samples were present for 172 patients (59·3 per cent) who had PBD and 118 (40·7 per cent) who did not. Contamination of bile was increased significantly in patients who underwent stenting (97·1 per cent versus 18·6 per cent in those without stenting; P < 0·001). PBD resulted in a shift in the biliary microbiome from Escherichia coli in non-stented patients (45 per cent versus 19·2 per cent in stented patients; P = 0·009) towards increased contamination with Enterococcus faecalis (9 versus 37·7 per cent respectively; P = 0·008) and Enterobacter cloacae (0 versus 20·4 per cent; P = 0·033). This shift was associated with a high incidence of bacterial resistance against ampicillin-sulbactam (63·6 per cent versus 18 per cent in patients with no PBD; P < 0·001), piperacillin-tazobactam (30·1 versus 0 per cent respectively; P = 0·003), ciprofloxacin (28·5 versus 5 per cent; P = 0·047) and imipenem (26·6 versus 0 per cent; P = 0·011). The rate of wound infection was higher in patients with a positive bile culture (21·0 per cent versus 6 per cent in patients with sterile bile; P = 0·002). Regression analysis revealed the presence of Enterococcus faecium (odds ratio 2·83, 95 per cent c.i. 1·17 to 6·84; P = 0·021) and Citrobacter species (odds ratio 5·09, 1·65 to 15·71; P = 0·005) as independent risk factors for postoperative wound infection. CONCLUSION There are fundamental differences in the biliary microbiome of patients with periampullary cancer who undergo PBD and those who do not. PBD induces a shift of the biliary microbiome towards a more aggressive and resistant spectrum, which requires a differentiated perioperative antibiotic treatment strategy.
Collapse
Affiliation(s)
- F Scheufele
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - L Aichinger
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Jäger
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - I E Demir
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - S Schorn
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Sargut
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Erkan
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, Koç University Hospital, Istanbul, Turkey
| | - J Kleeff
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, University of Liverpool, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - H Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - G O Ceyhan
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| |
Collapse
|
18
|
Angiolini MR, Gavazzi F, Ridolfi C, Moro M, Morelli P, Montorsi M, Zerbi A. Role of C-Reactive Protein Assessment as Early Predictor of Surgical Site Infections Development after Pancreaticoduodenectomy. Dig Surg 2016; 33:267-75. [PMID: 27216609 DOI: 10.1159/000445006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are extremely common in pancreatic surgery and explain its considerable morbidity and mortality, even in tertiary centers. Early detection of these complications, with the help of laboratory assays, improve clinical outcome. The aim of the present study is to evaluate C-reactive protein (CRP) diagnostic accuracy as early predictor of SSIs after pancreaticoduodenectomy (PD). METHODOLOGY We considered 251 consecutive PD. We prospectively recorded preoperative clinical and anthropometric data, intraoperative details and the postoperative outcome. In the first pool of consecutive patients (n = 150), we analyzed CRP levels from postoperative day 1 to 7 and investigated the prediction of SSIs. We then validated the diagnostic accuracy on the following 101 consecutive cases. RESULTS At multivariate analysis, high BMI and preoperative biliary stenting appeared to be independently associated with SSIs and organ-space SSI development. The CRP cutoff of 17.27 mg/dl on postoperative day 3 (78% sensitivity, 79% specificity) and of 14.72 mg/dl on postoperative day 4 (87% sensitivity, 82% specificity) was in a position to predict the course of 78.2 and 80.2% of patients, respectively. CONCLUSIONS CRP on postoperative days 3 and 4 seems able to predict postoperative course, selecting patients deserving intensification of diagnostic assessment; patients not satisfying these conditions could be reasonably directed toward early discharge.
Collapse
Affiliation(s)
- Maria Rachele Angiolini
- Section of Pancreatic Surgery, Department of General Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | | | | | | | | |
Collapse
|
19
|
Shi S, Xia W, Guo H, Kong H, Zheng S. Unique characteristics of pyogenic liver abscesses of biliary origin. Surgery 2016; 159:1316-24. [DOI: 10.1016/j.surg.2015.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 10/21/2015] [Accepted: 11/11/2015] [Indexed: 02/08/2023]
|
20
|
Herzog T, Belyaev O, Akkuzu R, Hölling J, Uhl W, Chromik AM. The Impact of Bile Duct Cultures on Surgical Site Infections in Pancreatic Surgery. Surg Infect (Larchmt) 2015; 16:443-9. [DOI: 10.1089/sur.2014.104] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Torsten Herzog
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Germany
| | - Orlin Belyaev
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Germany
| | - Rehsan Akkuzu
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Germany
| | - Janine Hölling
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Germany
| | - Waldemar Uhl
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Germany
| | - Ansgar M. Chromik
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Germany
| |
Collapse
|
21
|
Xu C, Huang XE, Wang SX, Lv PH, Sun L, Wang FA. Comparison of Infection between Internal-External and External Percutaneous Transhepatic Biliary Drainage in Treating Patients with Malignant Obstructive Jaundice. Asian Pac J Cancer Prev 2015; 16:2543-6. [DOI: 10.7314/apjcp.2015.16.6.2543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
22
|
Xu C, Lv PH, Huang XE, Sun L, Wang SX, Wang FA. Internal-external percutaneous transhepatic biliary drainage for patients with malignant obstructive jaundice. Asian Pac J Cancer Prev 2014; 15:9391-4. [PMID: 25422230 DOI: 10.7314/apjcp.2014.15.21.9391] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the effect of internal-external percutaneous transhepatic biliary drainage (IEPTBD) for patients with malignant obstructive jaundice. METHODS During the period of January 2008 and July 2013, internal-external drainage was performed in 42 patients with malignant obstructive jaundice. During the procedure, if the guide wire could pass through the occlusion and into the duodenum, IEPTBD was performed. External drainage biliary catheter was placed if the occlusion was not crossed. Newly onset of infection, degree of bilirubin decrease and the survival time of patients were selected as parameters to evaluate the effect of IEPTBD. RESULTS Twenty newly onset of infection were recorded after procedure and new infectious rate was 47.6%. Sixteen patients with infection (3 before, 13 after drainage) were uncontrolled after procedure, 12 of them (3 before, 9 after drainage) died within 1 month. The mean TBIL levels declined from 299.53 umol/L before drainage to 257.62 umol/L after drainage, while uninfected group decline from 274.86 umol/L to 132.34 umol/Lp (P < 0.5). The median survival time for uninfected group was 107 days, and for infection group was 43 days (P < 0.05). CONCLUSIONS The IEPTBD drainage may increase the chance of biliary infection, reduce bile drainage efficiency and decrease the long-term prognosis, and the external drainage is a better choice for patients with malignant obstructive jaundice need to biliary drainage.
Collapse
Affiliation(s)
- Chuan Xu
- Department of Interventional Radiology, Subei People's Hospital of Jiangsu Province, Clinical Hospital of Yangzhou University, Yangzhou, China E-mail :
| | | | | | | | | | | |
Collapse
|
23
|
Surgical revision of hepaticojejunostomy strictures after pancreatectomy. Langenbecks Arch Surg 2014; 400:67-75. [PMID: 25277247 DOI: 10.1007/s00423-014-1246-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 08/21/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND After pancreatic surgery hepaticojejunostomy (HJ) stricture is a rare condition. Usually, management is conservative, while operative revision ("redo") is only rarely performed. METHODS This was an observational cohort design that analyzed the outcome of patients who had a surgical revision of HJ strictures after pancreatic surgery at a specialized pancreatic center. RESULTS During a period of 7 years from January 2004 until December 2010, 887 patients underwent pancreaticoduodenectomy (PD) or HJ. Among this patient population, 3 % (23/887) underwent a redo of the HJ secondary to stricture formation. Major symptoms of HJ strictures were recurrent cholangitis in 91 % (21/23) and jaundice in 39 % (9/23). The median time from the index operation until redo of the HJ was 16 ± 27 months. The median survival of patients with malignancy after redo of the HJ was 45 ± 67 months. Major surgical morbidity was 9 % (2/23), and mortality was 0 % (0/23). In 78 % (18/23), there were no further episodes of cholangitis after a median follow of 49 ± 73 months, while none of the patients with redo of the HJ developed a restenosis of the HJ. CONCLUSION Surgical revision (redo) of HJ strictures can be safely performed by an experienced pancreatic surgeon with a low morbidity without mortality with good long-term results.
Collapse
|
24
|
Herzog T, Belyaev O, Hessam S, Uhl W, Chromik AM. Management of Isolated Bile Leaks After Pancreatic Resections. J INVEST SURG 2014; 27:273-81. [DOI: 10.3109/08941939.2014.916368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
25
|
Jinkins LJ, Parmar AD, Han Y, Duncan CB, Sheffield KM, Brown KM, Riall TS. Current trends in preoperative biliary stenting in patients with pancreatic cancer. Surgery 2013; 154:179-89. [PMID: 23889947 DOI: 10.1016/j.surg.2013.03.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/28/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sufficient evidence suggests that preoperative biliary stenting is associated with increased complication rates after pancreaticoduodenectomy. METHODS Surveillance, Epidemiology, and End Results (SEER) and linked Medicare claims data (1992-2007) were used to identify patients with pancreatic cancer who underwent pancreaticoduodenectomy. We evaluated trends in the use of preoperative biliary stenting, timing of physician visits relative to stenting, and time to surgical resection and symptoms in stented and unstented patients. RESULTS Pancreaticoduodenectomy was performed in 2,573 patients, and 52.6% of patients underwent preoperative biliary stenting (N = 1,354). Of these, 75.3% underwent endoscopic stenting only, 18.9% received a percutaneous stent, and 5.8% underwent both procedures. The overall stenting rate increased from 29.6% of patients between 1992 and 1995 to 59.1% between 2004 and 2007 (P < .0001). Preoperative stenting was more common in patients with jaundice, cholangitis, pruritus, or coagulopathy (P < .05 for all). Of stented patients, 77.7% had had a stent placed prior to seeing a surgeon. Stenting prior to surgical consultation was associated with longer indwelling stent time compared to stenting after surgical consultation (37.3 vs 27.0 days, P < .0001). In addition, stented patients had longer times from surgeon visit to pancreatectomy than those who had not received stents (24.2 days vs 17.2 days, P < .0001). CONCLUSION Use of preoperative biliary stenting doubled between 1992 and 2007 despite evidence that stenting is associated with increased perioperative infectious complications. The majority of stenting occurred prior to surgical consultation and is associated with significant delay in time to operation. Surgeons should be involved early in order to prevent unnecessary stenting and improve outcomes.
Collapse
Affiliation(s)
- Lindsay J Jinkins
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX 77555-0541, USA
| | | | | | | | | | | | | |
Collapse
|