Specific antibiotic prophylaxis based on bile cultures is required to prevent postoperative infectious complications in pancreatoduodenectomy patients who have undergone preoperative biliary drainage
Specific antibiotic prophylaxis based on bile cultures is required to prevent postoperative infectious complications in pancreatoduodenectomy patients who have undergone preoperative biliary drainage
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DOI：
10.1007/s00268-007-9210-4
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发表时间：
2007-11-01
影响因子：
2.6
通讯作者：
Sueda, Taijiro
中科院分区：
文献类型：
--
作者：
Sudo, Takeshi;Murakami, Yoshiaki;Sueda, Taijiro
背景术前胆道引流(PBD)与胆汁细菌污染有关，但PBD对胰腺十二指肠切除术后并发症的影响仍存在争议。本研究的目的是了解胆汁污染的特征，以制定成功的针对胰腺十二指肠切除术的特异性抗生素预防策略。方法前瞻性评价91例壶腹周围肿瘤行胰腺十二指肠切除术的患者。根据术前胆汁培养选择预防性抗生素。结果引流组胆汁培养阳性率(78%)明显高于非引流组(36%)(P<；0.001)。在引流组，阳性胆汁培养以多菌为主(61%)，对头孢唑林(83%)、头孢美唑(72%)和头孢匹罗(%)等多种抗生素耐药。引流组和非引流组的总感染率分别为30%和22%，感染发生率分别为13%和11%，差异无统计学意义。结论PBD对胆汁微生物污染有显著影响，且具有较高的抗生素耐药率。因此，需要以胆汁培养为基础的特异性抗生素预防，以预防接受PBD的胰腺十二指肠切除术患者的感染并发症。
Background Preoperative biliary drainage (PBD) is associated with bacterial contamination of bile, but the effects of PBD on morbidity after pancreatoduodenectomy remain controversial. The aim of this study was to characterize bile contamination to develop successful specific antibiotic prophylactic strategies for pancreatoduodenectomy.Methods Ninety-one consecutive patients who underwent pancreatoduodenectomy for periampullary tumor were prospectively evaluated. Prophylactic antibiotics were selected based on preoperative bile cultures. Bile cultures and postoperative complications were compared in 46 patients who underwent PBD (drainage group) versus 45 patients who did not (nondrainage group).Results The incidence of positive bile cultures was higher in the drainage group (78%) than in the nondrainage group (36%) (P < 0.001). In the drainage group, positive bile cultures were frequently polymicrobial (61%) and demonstrated resistance to several antibiotics, including cefazolin (83%), cefmetazole (72%), and cefpirome (64%). Overall morbidity (30% and 22%) and infectious morbidity (13% and 11%) did not differ significantly between the drainage and nondrainage groups, respectively.Conclusions PBD had a notable influence on bile microbial contamination, including a higher rate of antibiotic resistance. Therefore, specific antibiotic prophylaxis based on bile culture is required for preventing infectious complications in pancreatoduodenectomy patients who undergo PBD.