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Surgical site infections after pancreaticoduodenectomy: Preoperative biliary system interventions and antimicrobial

Çağrı Bilgiç1, Şiran Keske2, Erman Sobutay1

  • 1American Hospital, General Surgery, Istanbul, Turkey.

International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases
|April 12, 2020
PubMed
Abstract

Insights

Preoperative bile duct catheterization increases surgical site infection (SSI) risk after pancreaticoduodenectomy, especially with multidrug-resistant (MDR) organisms. Avoid unnecessary procedures and monitor antimicrobial prophylaxis closely.

Area of Science:

  • Gastroenterology
  • Surgical Infections
  • Antimicrobial Resistance

Background:

  • Surgical site infection (SSI) rates are high following pancreaticoduodenectomy (PD).
  • Preoperative bile duct catheterization (PBDC) is a known risk factor for SSI, often involving multidrug-resistant (MDR) microorganisms.

Purpose of the Study:

  • To investigate the impact of PBDC on SSI development.
  • To analyze the role of PBDC in the emergence of MDR pathogens causing SSI.
  • To evaluate the effectiveness of antimicrobial prophylaxis in patients undergoing PD with PBDC.

Main Methods:

  • Retrospective study of 214 patients undergoing PD or total pancreatectomy from 2010-2018.
  • Comparison of SSI rates and microbial profiles between patients with and without PBDC.
  • Multivariate analysis to identify risk factors for SSI.

Main Results:

  • PBDC was used in 29% of patients, associated with higher intraoperative bile fluid culture positivity (84% vs. 17%).
  • Overall SSI rate was 24%; PBDC significantly increased SSI risk (OR: 2.33, p=0.02).
  • Pseudomonas spp. and MDR pathogens were more frequent in the PBDC group, with higher resistance to ampicillin-sulbactam (87.5% vs. 25%).

Conclusions:

  • Unnecessary PBDC should be avoided to reduce SSI risk.
  • Clinicians must monitor for increasing antimicrobial resistance in SSI pathogens.
  • Careful selection of antimicrobial prophylaxis is crucial in PD patients, especially those with PBDC.
Keywords:
PancreaticoduodenectomyPreoperative biliary system interventionsSurgical prophylaxisSurgical site infections

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