[Guidelines for adequate antibiotic prophylaxis after hepatic, biliary, and pancreatic surgery]

The recent spectrum of bacteria isolated from patients with hepatic, biliary, and pancreatic infections mostly consists of Gram negative rods translocated from their intestinal flora. Cephem or carbapenem antibiotics should be selected based on the severity of surgical infection and risk to each patient to prevent postoperative infections. Once postoperative infection occurs, surgical procedures such as ultrasonography-guided percutaneous biliary drainage should be performed to reduce inflammation and to obtain samples for bacterial culture. The most commonly identified bacteria after hepatic, biliary, and pancreatic surgery are Pseudomonas species, MRSA, and Enterococcus species. Previously administered antimicrobial agents should be immediately interrupted and empiric antibiotic therapy with carbapenem started. Vancomycin or teicoplanin is selected when MRSA or Enterococcus faecium infection is suspected. Infection control systems should be in place for prevention of postoperative MRSA infections.