Significance of blood culture testing after pancreatoduodenectomy

Area of Science:

• Surgical Oncology
• Infectious Diseases
• Clinical Microbiology

Background:

• Pancreatoduodenectomy (PD) is a complex surgical procedure with potential postoperative complications.
• Febrile episodes (FEs) are common post-PD, necessitating accurate diagnosis.
• Blood culture testing is a key diagnostic tool for identifying bloodstream infections.

Purpose of the Study:

• To evaluate the significance of blood culture testing in the postoperative period following pancreatoduodenectomy.
• To determine blood culture sampling and positivity rates in patients experiencing febrile episodes post-PD.
• To explore factors associated with blood culture positivity and differentiate fever origins.

Main Methods:

• Retrospective analysis of patients undergoing PD between 2016-2021.
• Investigation of febrile episodes (temperature ≥38.0°C from postoperative day 4).
• Classification of FEs as pancreatic fistula (PF)-related or PF-unrelated, with correlation analysis for blood culture positivity.

Main Results:

• Of 339 PD patients, 99 experienced 202 FEs; 160 FEs underwent blood culture testing.
• Blood culture positivity rates were 17.5% per episode and 28.1% per patient.
• PF-unrelated FEs showed significantly higher positivity rates (27/124) than PF-related FEs (1/36).
• Positive blood cultures were associated with cholangitis, catheter-related bloodstream infection, urinary tract infection, shivering, Pitt Bacteremia Score, and preoperative biliary drainage.

Conclusions:

• Patients undergoing PD exhibit notable blood culture positivity rates in the postoperative period.
• Blood culture results can aid in distinguishing between pancreatic fistula-related and unrelated febrile episodes.
• Further investigation into specific infection markers may refine differential diagnosis post-PD.