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Bacteriobilia resistance to antibiotic prophylaxis increases morbidity after pancreaticoduodenectomy: a monocentric retrospective study of 128 patients

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Abstract

Several studies attempted to determine whether there is a relationship between the use of preoperative biliary drainage and morbidity after pancreaticoduodenectomy (PD). We retrospectively evaluated post-PD outcome in patients with and without preoperative biliary drainage and the role of bacteriobilia and antibiotic prophylaxis in post-operative complications. Data relating to the PDs performed at the Hepato-Bilio-Pancreatic Surgical Department of Treviso Hospital between 2010 and 2017 were retrospectively evaluated. Morbidity and intra-hospital mortality related to preoperative biliary stent were the primary outcomes. Between 2010 and 2017, 128 patients (mean age 68 years) underwent PD; 72 were treated with early surgery (ES) and 56 underwent preoperative biliary drainage (PBD). Overall morbidity was 50% in the ES cohort and 43% in the PBD (ns, p = 0.43). In the PBD group, bacteriobilia was found in the 100% of the bile cultures (48; 8 unavailable). The microbiota was represented by: Klebsiella spp (48%), Enterococcus spp (29%), E. coli (27%) and Candida spp (21%). In 52% of cases, at least one of the isolated bacteria was resistant to the perioperative antibiotic prophylaxis (69% of cases Amoxicillin–Clavulanic Ac.). The majority of postoperative surgical complications occurred in patients with prophylaxis-resistant bacteriobilia (68% vs 39%; p = 0.04). Antibiotic resistance is a determining factor in morbidity after PD. We therefore propose to pay particular attention to the preoperative prophylaxis, diversifying it between drained and non-drained patients. In fact, in the former, appropriate broad spectrum preoperative antibiotic coverage is strongly suggested.

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Authors and Affiliations

  1. UOC Terza Chirurgia Generale, Azienda ULSS2 Marca Trevigiana, Piazza Ospedale 1, 31100, Treviso, Italy

    Tommaso Stecca, Cristina Nistri, Bruno Pauletti, Alessandra Greco, Adriana Di Giacomo, Ezio Caratozzolo, Luca Bonariol & Marco Massani

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  1. Tommaso Stecca
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  2. Cristina Nistri
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  3. Bruno Pauletti
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  4. Alessandra Greco
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  5. Adriana Di Giacomo
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  6. Ezio Caratozzolo
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  7. Luca Bonariol
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  8. Marco Massani
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by TS, CN, BP, AG and MM. The first draft of the manuscript was written by TS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Tommaso Stecca.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Stecca, T., Nistri, C., Pauletti, B. et al. Bacteriobilia resistance to antibiotic prophylaxis increases morbidity after pancreaticoduodenectomy: a monocentric retrospective study of 128 patients. Updates Surg 72, 1073–1080 (2020). https://doi.org/10.1007/s13304-020-00772-z

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  • DOI: https://doi.org/10.1007/s13304-020-00772-z

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