Department of Hepatobiliary and Pancreatic Surgery, Centre for Digestive System Diseases, Beaujon Hospital AP-HP (Assistance-Publique-Hôpitaux de Paris), Clichy.
HPB (Oxford). 2013 Jun;15(6):473-80. doi: 10.1111/hpb.12012. Epub 2012 Dec 5.
Pancreaticoduodenectomy (PD) is associated with high morbidity, in part as a result of infectious complications increased by preoperative bile contamination. The aim of the present study was to assess the effect on the incidence of infectious complications of short-term antimicrobial therapy (AMT) in high-risk patients.
Patients with a high risk for positive intraoperative bile culture (i.e. those with ampulloma or pancreatic adenocarcinoma with preoperative endoscopic procedures) (high-risk group, n = 99) were compared with low-risk patients (i.e. those with pancreatic adenocarcinoma without preoperative endoscopic procedures) (low-risk group, n = 76). The high-risk group received a 5-day course of perioperative AMT secondarily adapted to the bile antibiogram. The low-risk group received only the usual antimicrobial prophylaxis.
Positive bile cultures were significantly more frequent in high-risk patients (81% versus 12%; P < 0.001). The overall rate of infectious complications was lower in the high-risk group (29% versus 46%; P = 0.018). The statistically significant decrease in the rate of infectious complications reflected reduced rates of urinary tract infections, pulmonary infections and septicaemia. Rates of wound infection (3% versus 5%; P = 0.639) and intra-abdominal abscess (7% versus 7%; P = 0.886) were similar in the high- and low-risk groups, as was the need for curative AMT.
This exploratory study suggests that a postoperative short course of AMT in patients at high risk for biliary contamination reduces the overall rate of infectious complications after PD. The adaptation of perioperative antimicrobial policy to the patient's risk for bile contamination seems promising and should be further evaluated.
胰十二指肠切除术（PD）与高发病率相关，部分原因是术前胆汁污染导致感染并发症增加。本研究旨在评估短期抗菌治疗（AMT）对高危患者感染并发症发生率的影响。
将具有术中胆汁培养阳性高风险的患者（即有壶腹肿瘤或有术前内镜检查的胰腺腺癌患者）（高危组，n=99）与低风险患者（即无术前内镜检查的胰腺腺癌患者）（低危组，n=76）进行比较。高危组接受 5 天的围手术期 AMT，其次是根据胆汁药敏谱进行调整。低危组仅接受常规抗菌预防。
高危组胆汁培养阳性率显著更高（81%比 12%；P＜0.001）。高危组感染并发症总发生率较低（29%比 46%；P=0.018）。感染并发症发生率的统计学显著降低反映了尿路感染、肺部感染和败血症发生率的降低。高危组和低危组的伤口感染率（3%比 5%；P=0.639）和腹腔脓肿率（7%比 7%；P=0.886）相似，需要治愈性 AMT 的情况也相似。
这项探索性研究表明，对于有胆汁污染高风险的患者，术后短期 AMT 可降低 PD 后总体感染并发症发生率。根据患者胆汁污染风险调整围手术期抗菌策略似乎有前景，应进一步评估。
