Specific antibiotic prophylaxis based on bile cultures is required to prevent postoperative infectious complications in pancreatoduodenectomy patients who have undergone preoperative biliary drainage

Sudo Takeshi

Murakami Yoshiaki

Uemura Kenichiro

Hayashidani Yasuo

Hashimoto Yasushi

Ohge Hiroki

Sueda Taijiro

World Journal of Surgery

Background Preoperative biliary drainage (PBD) is associated with bacterial contamination of bile, but the effects of PBD on morbidity after pancreatoduodenectomy remain controversial. The aim of this study was to characterize bile contamination to develop successful specific antibiotic prophylactic strategies for pancreatoduodenectomy. Methods Ninety-one consecutive patients who underwent pancreatoduodenectomy for periampullary tumor were prospectively evaluated. Prophylactic antibiotics were selected based on preoperative bile cultures. Bile cultures and postoperative complications were compared in 46 patients who underwent PBD (drainage group) versus 45 patients who did not (nondrainage group). Results The incidence of positive bile cultures was higher in the drainage group (78%) than in the nondrainage group (36%) (P < 0.001). In the drainage group, positive bile cultures were frequently polymicrobial (61%) and demonstrated resistance to several antibiotics, including cefazolin (83%), cefmetazole (72%), and cefpirome (64%). Overall morbidity (30-0x1.fd580000008p+0nd 22%) and infectious morbidity (13 0x1.f72676b636142p+855nd 11%) did not differ significantly between the drainage and nondrainage groups, respectively. Conclusions PBD had a notable influence on bile microbial contamination, including a higher rate of antibiotic resistance. Therefore, specific antibiotic prophylaxis based on bile culture is required for preventing infectious complications in pancreatoduodenectomy patients who undergo PBD.

Medical sciences [ 490 ]

eng

Springer

Copyright(c) 2007 Springer

The original publication is available at www.springerlink.com

[ISSN] 0364-2313

[DOI] 10.1007/s00268-007-9210-4

[NCID] AA0089099X

[DOI] http://dx.doi.org/10.1007/s00268-007-9210-4 isVersionOf