Abstract
Background
Surgical site infections are common after pancreaticoduodenectomy. Our institution
routinely performs intraoperative bile culture with pancreaticoduodenectomy. Herein
we examined whether antibiotic selection based on bile culture analysis reduced the
surgical site infection risk after pancreaticoduodenectomy.
Methods
A total of 349 patients underwent pancreaticoduodenectomy with intraoperative bile
cultures in our institution between 2008 and 2019. Patients were categorized into
“group A” (196 patients who underwent pancreaticoduodenectomy between 2008 and 2013)
or “group B” (153 patients who underwent pancreaticoduodenectomy between 2018 and
2019). Group A received cefazoline perioperatively and for 2 days postoperatively,
whereas group B received piperacillin-tazobactam instead based on the bile culture
findings in group A.
Results
In group A, 91 (46.4%) intraoperative bile cultures were positive, and surgical site
infections occurred in 61 patients (31.1%). A total of 32 patients had both positive
bile culture and surgical site infection, of whom 23 (71.9%) exhibited the same microorganisms
in the biliary and surgical site infection cultures. Due to the common finding of
cefazoline-resistant Enterococcus spp. and Enterobacter spp. in group A, group B received piperacillin-tazobactam. Surgical site infection
incidence in group B was 18.3% (n = 28), which was significantly lower than in group A (P = .006). Cefazoline-resistant Enterococcus spp. and Enterobacter spp., respectively, were cultured in 69.8% and 24.3% of patients with preoperative
biliary drainage, compared with 32.2% and 9.7% of patients without preoperative biliary
drainage.
Conclusion
The perioperative selection of antibiotics based on bile culture findings at pancreaticoduodenectomy
can reduce the incidence of surgical site infection.
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Article info
Publication history
Published online: December 20, 2022
Accepted:
November 20,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
