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Preoperative surveillance rectal swab is associated with an increased risk of infectious complications in pancreaticoduodenectomy and directs antimicrobial prophylaxis: an antibiotic stewardship strategy?
- Source :
-
HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2018 Jun; Vol. 20 (6), pp. 555-562. Date of Electronic Publication: 2018 Jan 12. - Publication Year :
- 2018
-
Abstract
- Background: Despite improvements in the perioperative care, the morbidity rate after pancreaticoduodenectomy (PD) is still higher than 50%. The aim of this study was twofold: first, to assess the correlation between preoperative rectal swab (RS) and intraoperative bile cultures; to examine the impact of RS isolates on postoperative course after PD.<br />Methods: An observational study was conducted analyzing all consecutive PD performed from January 2015 to July 2016. Based on the positivity/negativity of preoperative RS for multi-drug resistant bacteria, two groups of patients were identified (RS+ vs. RS-) and then compared.<br />Results: Three hundred thirty-eight patients were considered for the analysis. RS culture showed a perfect correlation (species and phenotypic antibiotic susceptibility pattern) with bile culture in 157 patients (86.7%). Fifty patients (14.8%) had a RS+. Preoperative biliary drain (PBD) was the single independent preoperative risk factor associated to RS+ (p = 0.021, OR = 2.6, 95% CI = 1.5-11.7). Infective complications (IC) and mortality were independently correlated to RS+ (p = 0.013, OR = 2.9, 95% CI = 1.3-6.7; p = 0.009 OR = 3.4, 95% CI = 1.8-14.9, respectively).<br />Conclusions: Preoperative surveillance RS-culture's positivity correlates to biliary colonization that occurs after PBD. IC and mortality after PD are associated with RS+. Preoperative RS can direct antibiotic prophylaxis to reduce morbidity and mortality after PD.<br /> (Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
- Subjects :
- Aged
Anti-Bacterial Agents adverse effects
Antibiotic Prophylaxis adverse effects
Antibiotic Prophylaxis mortality
Bacteriological Techniques
Bile microbiology
Databases, Factual
Drainage mortality
Drug Resistance, Multiple, Bacterial
Female
Humans
Male
Middle Aged
Pancreaticoduodenectomy mortality
Retrospective Studies
Risk Assessment
Risk Factors
Surgical Wound Infection diagnosis
Surgical Wound Infection microbiology
Surgical Wound Infection mortality
Treatment Outcome
Anti-Bacterial Agents administration & dosage
Antibiotic Prophylaxis methods
Antimicrobial Stewardship
Drainage adverse effects
Pancreaticoduodenectomy adverse effects
Rectum microbiology
Surgical Wound Infection prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1477-2574
- Volume :
- 20
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- HPB : the official journal of the International Hepato Pancreato Biliary Association
- Publication Type :
- Academic Journal
- Accession number :
- 29336894
- Full Text :
- https://doi.org/10.1016/j.hpb.2017.12.002