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Antimicrobial susceptibility of biliary stents do not predict infectious complications after whipple
Lawrence M Knab1, Mary Varsanik2, Ruojia Li1
1Department of Surgery, Loyola University Medical Center, Maywood, IL.
Background:
Postoperative infectious complications after a pancreaticoduodenectomy remain a significant cause of morbidity. Studies have demonstrated that a preoperative biliary stent increases the risk of postoperative infectious complications. Few studies have investigated the specific preoperative biliary stent bacterial sensitivities to preoperative antibiotics and the effect on infectious complications. The goal of this study was to investigate if the presence of a preoperative biliary stent increases the risk of postoperative infectious complications in patients undergoing a pancreaticoduodenectomy. Additionally, we aimed to investigate biliary stent culture sensitivities to preoperative antibiotics and determine if those sensitivities impacted postoperative infectious complications after a pancreaticoduodenectomy.
Methods:
A retrospective chart review of patients who had undergone a pancreaticoduodenectomy at a single institution tertiary care center from 2007 to 2018 was performed. Perioperative variables including microbiology cultures from biliary stents were collected and analyzed.
Results:
A total of 244 patients underwent a pancreaticoduodenectomy. A preoperative biliary stent was present in 45 (18%) patients. Infectious complications occurred in 25% of those patients with a preoperative biliary stent, and 19% of those without (P = .37). Of those patients with a stent that was cultured intraoperatively, 92% grew bacteria and 61% of those were resistant to the preoperative antibiotics administered. Of the patients with a preoperative biliary stent and bacteria resistant to the preoperative antibiotics, 17% developed a postoperative infectious complication, compared with 20% if the bacteria cultured was susceptible to the preoperative antibiotics (P = .64).
Conclusion:
Infectious complications after pancreaticoduodenectomy are a significant cause of morbidity. Stent bacterial sensitivities to preoperative antibiotics did not reduce the postoperative infectious complications in the preoperative biliary stent group suggesting a multifactorial cause of infections.
Insights
Preoperative biliary stents in pancreaticoduodenectomy patients did not significantly increase infectious complications. Biliary stent bacterial resistance to antibiotics also did not impact postoperative infection rates, suggesting multifactorial causes.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Infectious Diseases
Background:
- Postoperative infectious complications are a significant morbidity after pancreaticoduodenectomy.
- Preoperative biliary stents are suspected to increase infectious risk, but their specific impact and bacterial sensitivities are understudied.
Purpose of the Study:
- To determine if preoperative biliary stents increase postoperative infectious complications in pancreaticoduodenectomy patients.
- To analyze biliary stent bacterial sensitivities to preoperative antibiotics and their effect on infectious complications.
Main Methods:
- Retrospective chart review of 244 pancreaticoduodenectomy patients from 2007-2018.
- Collection and analysis of perioperative variables, including intraoperative biliary stent cultures.
Main Results:
- Infectious complications occurred in 25% of patients with a stent vs. 19% without (P=.37).
- 92% of cultured stents grew bacteria, with 61% resistant to preoperative antibiotics.
- Postoperative infection rates were similar whether bacteria were resistant (17%) or susceptible (20%) to antibiotics.
Conclusions:
- Preoperative biliary stents did not significantly increase postoperative infectious complications in this cohort.
- Bacterial sensitivities of biliary stents to preoperative antibiotics did not appear to influence postoperative infection rates, suggesting multifactorial causes for these complications.
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