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Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Efficacy of Pre-Operative Antimicrobial Prophylaxis in Patients Undergoing Pancreatoduodenectomy: A Multi-Center
Judith E K R Hentzen1, Marloes A Smit2, Marjan J Bruins3
11 Department of Surgery, Isala, Zwolle, The Netherlands .
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 PD-with and without PBD-to 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.
Insights
Pre-operative biliary drainage (PBD) before pancreaticoduodenectomy (PD) increases infectious complications. Adding gentamicin to standard prophylaxis may improve pathogen coverage and prevent post-operative infections.
Area of Science:
- Surgical Oncology
- Infectious Diseases
- Pharmacology
Background:
- Infectious complications are common after pancreaticoduodenectomy (PD), despite standard antibiotic prophylaxis.
- Pre-operative biliary drainage (PBD) is a known risk factor for these infectious complications.
Purpose of the Study:
- To identify pathogens in intra-operative bile cultures from patients undergoing PD.
- To determine optimal antimicrobial prophylaxis by comparing patients with and without PBD.
Main Methods:
- Retrospective analysis of 352 patients undergoing PD between 2009 and 2016.
- Analysis of intra-operative bile cultures to identify microorganisms.
- Evaluation of standard prophylaxis (cefazolin and metronidazole) effectiveness.
Main Results:
- Positive bile cultures were significantly higher in the PBD group (87.9%) compared to the non-PBD group (31.8%).
- Common pathogens included Enterococcus, Streptococcus, and Klebsiella species.
- Standard prophylaxis provided adequate coverage in only 71% of patients.
Conclusions:
- PBD increases microbial colonization and antibiotic resistance in patients undergoing PD.
- Adding gentamicin to standard prophylaxis could achieve near-complete pathogen coverage (99-100%).
- Gentamicin may be a valuable addition to antimicrobial prophylaxis to prevent infectious complications after PD.
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