Skip to main content

Advertisement

SpringerLink
Log in

Bacteremia after hepatectomy and biliary reconstruction for biliary cancer: the characteristics of bacteremia according to occurrence time and associated complications

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Bacteremia occurring after extensive hepatic resection and biliary reconstruction (Hx + Bx) for biliary cancer is a critical infectious complication. This study evaluated postoperative bacteremia and examined the potential usefulness of surveillance cultures.

Methods

We retrospectively reviewed 179 patients who underwent Hx + Bx for biliary cancer from January 2008 to December 2018 in our department.

Results

Bacteremia occurred in 41 (23.0%) patients. Patients with bacteremia had a longer operation time and more frequent intraoperative transfusion and more frequently developed organ/space surgical site infection (SSI) than those without bacteremia. The most frequently isolated bacterial species from blood cultures were Enterococcus faecium (29.3%), Enterobacter cloacae (24.4%), and Enterococcus faecalis (22.0%). The SIRS duration of bacteremia associated with organ/space SSI was significantly longer than that of other infectious complications (median 96 h vs. 48 h; p = 0.043). Bacteremia associated with organ/space SSI occurred most often by postoperative day (POD) 30. The concordance rate of bacterial species between blood and surveillance cultures within POD 30 was 67–82%.

Conclusions

Bacteremia associated with organ/space SSI required treatment for a long time and typically occurred by POD 30. Postoperative surveillance cultures obtained during this period may be useful for selecting initial antibiotic therapy because of their high concordance rate with blood cultures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

Hx + Bx:

Extensive hepatic resection and biliary reconstruction

SSI:

Surgical site infection

POD:

Postoperative day

HPB:

Hepato-pancreato-biliary

SIRS:

Systemic inflammatory response syndrome

ISGPF:

International Study Group on Pancreatic Fistula Definition

TG18:

Tokyo Guidelines 2018

PTPE:

Percutaneous transhepatic portal vein embolization

ENBD:

Endoscopic naso-biliary drainage

ERB:

Endoscopic retrobiliary drainage

PTBD:

Percutaneous transhepatic biliary drainage

SSI:

Surgical site infection

MRSA:

Methicillin-resistant Staphylococcus aureus

MRSE:

Methicillin-resistant Staphylococcus epidermidis

References

  1. Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K, et al. Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality. J Hepatobiliary Pancreat Sci. 2010;17:455–62.

    Article  Google Scholar 

  2. Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg. 2013;258:129–40.

    Article  Google Scholar 

  3. Van Gulik T, Kloek J, Ruys A, Busch O, Van Tienhoven G, Lameris J, et al. Multidisciplinary management of hilar cholangiocarcinoma (Klatskin tumor): extended resection is associated with improved survival. Eur J Surg Oncol. 2011;37:65–71.

    Article  Google Scholar 

  4. Young AL, Igami T, Senda Y, Adair R, Farid S, Toogood GJ, et al. Evolution of the surgical management of perihilar cholangiocarcinoma in a Western centre demonstrates improved survival with endoscopic biliary drainage and reduced use of blood transfusion. HPB. 2011;13:483–93.

    Article  Google Scholar 

  5. De Jong MC, Marques H, Clary BM, Bauer TW, Marsh JW, Ribero D, et al. The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases. Cancer. 2012;118:4737–47.

    Article  Google Scholar 

  6. Neuhaus P, Thelen A, Jonas S, Puhl G, Denecke T, Veltzke-Schlieker W, et al. Oncological superiority of hilar en bloc resection for the treatment of hilar cholangiocarcinoma. Ann Surg Oncol. 2012;19:1602–8.

    Article  Google Scholar 

  7. Shigeta H, Nagino M, Kamiya J, Uesaka K, Sano T, Yamamoto H, et al. Bacteremia after hepatectomy: an analysis of a single-center, 10-year experience with 407 patients. Langenbeck’s Arch Surg. 2002;387:117–24.

    Article  Google Scholar 

  8. Yang PS, Liu CP, Hsu YC, Chen CF, Lee CC, Cheng SP. A novel prediction model for bloodstream infections in hepatobiliary-pancreatic surgery patients. World J Surg. 2019;43:1294–302.

    Article  Google Scholar 

  9. Raman G, Avendano E, Berger S, Menon V. Appropriate initial antibiotic therapy in hospitalized patients with gram-negative infections: systematic review and meta-analysis. BMC Infect Dis. 2015;15:395.

    Article  Google Scholar 

  10. Marquet K, Liesenborgs A, Bergs J, Vleugels A, Claes N. Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis. Crit Care. 2015;19:63.

    Article  Google Scholar 

  11. Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, et al. Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother. 2005;49:760–6.

    Article  CAS  Google Scholar 

  12. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000;118:146–55.

    Article  CAS  Google Scholar 

  13. Noji T, Tanaka K, Matsui A, Nakanishi Y, Asano T, Nakamura T, et al. Transhepatic direct approach to the “limit of the division of the hepatic ducts” leads to a high r0 resection rate in perihilar cholangiocarcinoma. J Gastrointest Surg. 2021;25:2358–67.

    Article  Google Scholar 

  14. Nakanishi Y, Hirano S, Okamura K, Tsuchikawa T, Nakamura T, Noji T, et al. Clinical and oncological benefits of left hepatectomy for Bismuth type I/II perihilar cholangiocarcinoma. Surg Today. 2021. https://doi.org/10.1007/s00595-021-02401-7.

    Article  PubMed  Google Scholar 

  15. Tamoto E, Hirano S, Tsuchikawa T, Tanaka E, Miyamoto M, Matsumoto J, et al. Portal vein resection using the no-touch technique with a hepatectomy for hilar cholangiocarcinoma. HPB (Oxford). 2014;16:56–61.

    Article  Google Scholar 

  16. Okamura K, Tanaka K, Miura T, Nakanishi Y, Noji T, Nakamura T, et al. Randomized controlled trial of perioperative antimicrobial therapy based on the results of preoperative bile cultures in patients undergoing biliary reconstruction. J Hepatobiliary Pancr Sci. 2017;24:382–93.

    Article  Google Scholar 

  17. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest. 1992;101:1644–55.

    Article  CAS  Google Scholar 

  18. Zilberberg MD, Shorr AF, Micek ST, Vazquez-Guillamet C, Kollef MH. Multi-drug resistance, inappropriate initial antibiotic therapy and mortality in Gram-negative severe sepsis and septic shock: a retrospective cohort study. Crit Care. 2014;18:596.

    Article  Google Scholar 

  19. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  Google Scholar 

  20. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;B240:205–13.

    Article  Google Scholar 

  21. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20:250–78.

    Article  CAS  Google Scholar 

  22. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161:584–91.

    Article  Google Scholar 

  23. Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149:680–8.

    Article  Google Scholar 

  24. Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25:17–30.

    Article  Google Scholar 

  25. Nagino M, Nishio H, Ebata T, Yokoyama Y, Igami T, Nimura Y. Intrahepatic cholangiojejunostomy following hepatobiliary resection. Br J Surg. 2007;94:70–7.

    Article  CAS  Google Scholar 

  26. Nakahira S, Shimizu J, Miyamoto A, Kobayashi S, Umeshita K, Ito T, et al. Proposal for a sub-classification of hepato-biliary-pancreatic operations for surgical site infection surveillance following assessment of results of prospective multicenter data. J Hepatobiliary Pancreat Sci. 2013;20:504–11.

    Article  Google Scholar 

  27. Sakata J, Shirai Y, Tsuchiya Y, Wakai T, Nomura T, Hatakeyama K. Preoperative cholangitis independently increases in-hospital mortality after combined major hepatic and bile duct resection for hilar cholangiocarcinoma. Langenbecks Arch Surg. 2009;394:1065–72.

    Article  Google Scholar 

  28. Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. One hundred consecutive hepatobiliary resections for biliary hilar malignancy: preoperative blood donation, blood loss, transfusion, and outcome. Surgery. 2005;137:148–55.

    Article  Google Scholar 

  29. Abraham K, Dolman HS, Zimmerman LH, Faris J, Edelman DA, Baylor A, et al. Impact of inappropriate initial antibiotics in critically ill surgical patients with bacteremia. Am J Surg. 2016;211:593–8.

    Article  Google Scholar 

  30. Davies SW, Efird JT, Guidry CA, Hranjec T, Metzger R, Swenson BR, et al. Does it matter if we get it right? Impact of appropriateness of empiric antimicrobial therapy among surgical patients. Shock. 2014;42:185–91.

    Article  CAS  Google Scholar 

  31. Sugawara G, Ebata T, Yokoyama Y, Igami T, Takahashi Y, Takara D, et al. The effect of preoperative biliary drainage on infectious complications after hepatobiliary resection with cholangiojejunostomy. Surgery. 2013;153:200–10.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Editage (www.editage.com) for the English language editing. No financial support was received for this study.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan

    Junki Fukuda, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura & Satoshi Hirano

Authors
  1. Junki Fukuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kimitaka Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aya Matsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshitsugu Nakanishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toshimichi Asano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takehiro Noji
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toru Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takahiro Tsuchikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Keisuke Okamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Satoshi Hirano
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design, analysis and interpretation of data and drafting of manuscript: JF and KT. Acquisition of data; JF, KT, YN, TN, and KO. All authors discussed or revised the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Kimitaka Tanaka.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fukuda, J., Tanaka, K., Matsui, A. et al. Bacteremia after hepatectomy and biliary reconstruction for biliary cancer: the characteristics of bacteremia according to occurrence time and associated complications. Surg Today 52, 1373–1381 (2022). https://doi.org/10.1007/s00595-022-02462-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-022-02462-2

Keywords

Search

Navigation