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Early postoperative drainage fluid culture positivity from contaminated bile juice is predictive of pancreatic fistula after pancreaticoduodenectomy

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Abstract

Purpose

To investigate the impact of early postoperative drainage fluid culture positivity on the development of clinically relevant postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).

Methods

We assessed the positive prevalence, distribution, and drug sensitivity of microorganisms in drainage fluid collected on postoperative day (POD) 1 after PD from 465 patients.

Results

Culture results were positive in pancreaticojejunostomy (PJ) drainage fluid from 26.0% of patients. Similar distributions of microorganisms were observed in the bile juice and PJ/hepaticojejunostomy (HJ) drainage fluid from these patients. PJ drain culture positivity was associated with an elevated drainage amylase level and with preoperative biliary drainage. No associations were seen between HJ drainage culture positivity and the drainage amylase and bilirubin levels. PJ drainage culture positivity was found to be an independent predictor of grade B/C POPF. According to the antibiogram, the bacteria identified were likely to be resistant to prophylactic antibiotics.

Conclusions

PJ drainage culture positivity on POD 1 in combination with an elevated drainage amylase level is an early predictor of grade B/C POPF. PJ drainage culture positivity may be attributable to bile juice contamination caused by intraoperative spillage and early postoperative leakage from the PJ anastomotic sites.

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Authors and Affiliations

  1. Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Tatsuo Hata, Masamichi Mizuma, Fuyuhiko Motoi, Kei Nakagawa, Kunihiro Masuda, Masaharu Ishida, Takanori Morikawa, Hiroki Hayashi, Takashi Kamei, Takeshi Naitoh & Michiaki Unno

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  1. Tatsuo Hata
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  2. Masamichi Mizuma
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  3. Fuyuhiko Motoi
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Correspondence to Tatsuo Hata.

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Electronic supplementary material

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595_2019_1885_MOESM1_ESM.tiff

Supplementary Fig. S1. Scheme of reconstruction following pancreaticoduodenectomy. PJ, pancreaticojejunostomy; HJ, hepaticojejunostomy (TIFF 1758 kb)

595_2019_1885_MOESM2_ESM.tiff

Supplementary Figure S2. (a) PJ drainage amylase level on POD 1 according to the PJ drain culture results. (b) Serum CRP level on POD 1 according to the PD drainage culture results. (c) HJ drainage amylase level on POD 1 according to the HJ drainage culture results. (d) HJ drainage bilirubin level on POD 1 according to the HJ culture results. The box represents the 25–75th percentiles and the line within the box is the median value. PJ, pancreaticojejunostomy; HJ, hepaticojejunostomy (TIFF 1524 kb)

595_2019_1885_MOESM3_ESM.tiff

Supplementary Fig. S3. Preoperative and postoperative serum levels of CRP in patients with vs. those without grade B/C POPF. The box represents the 25–75th percentiles, and the line within the box is the median value. POPF, postoperative pancreatic fistula (TIFF 934 kb)

595_2019_1885_MOESM4_ESM.tiff

Supplementary Fig. S4. PJ drainage amylase level on POD 1 and POD 3 from patients with vs. those without grade B/C POPF. The box represents the 25–75th percentiles, and the line within the box is the median value. Each median value is shown in the box. POPF, postoperative pancreatic fistula (TIFF 851 kb)

Supplementary material 5 (DOCX 16 kb)

Supplementary material 6 (DOCX 23 kb)

Supplementary material 7 (DOCX 17 kb)

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Hata, T., Mizuma, M., Motoi, F. et al. Early postoperative drainage fluid culture positivity from contaminated bile juice is predictive of pancreatic fistula after pancreaticoduodenectomy. Surg Today 50, 248–257 (2020). https://doi.org/10.1007/s00595-019-01885-8

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  • DOI: https://doi.org/10.1007/s00595-019-01885-8

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