Müssle Benjamin, Hempel Sebastian, Kahlert Christoph, Distler Marius, Weitz Jürgen, Welsch Thilo
Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
World J Surg. 2018 Sep;42(9):2951-2962. doi: 10.1007/s00268-018-4546-5.
Intraoperative bile analysis during pancreatoduodenectomy (PD) is performed routinely at specialized centers worldwide. However, it remains controversial if and how intraoperative bacterobilia during PD affects morbidity and its management. The aim of the study was a systematic review and meta-analysis of intraoperative bacterobilia and its impact on patient outcome after PD.
Five relevant outcomes of interest were defined, and a systematic review of the literature with meta-analysis was performed according to the PRISMA guidelines.
A total of 28 studies (8523 patients) were included. The median incidence of bacterobilia was 58% (interquartile range 51-67%). The most frequently isolated bacteria were Enterococcus species (51%), Klebsiella species (28%), and Escherichia coli (27%). Preoperative biliary drainage was significantly associated with bacterobilia (86 vs. 25%; RR 3.27; 95% confidence interval (CI) 2.42-4.42; p < 0.001). The incidence of surgical site infections (SSI) was significantly increased in cases with bacterobilia (RR 2.84; 95% CI 2.17-3.73; p < 0.001). Postoperative pancreatic fistula, overall postoperative morbidity, and mortality were not significantly influenced. Identical bacteria in bile and the infectious sources were found in 48% (interquartile range 34-59%) of the cases.
Bacterobilia is detected during almost every second PD and is associated with an increased rate of SSI. The microbiome from intraoperative bile and postoperative infectious sources match in ~50% of patients, providing the option of early administration of calculated antibiotics and the determination of resistance patterns.
在全球的专业中心，胰十二指肠切除术（PD）期间进行术中胆汁分析是常规操作。然而，PD术中胆汁菌血症是否以及如何影响发病率及其管理仍存在争议。本研究的目的是对术中胆汁菌血症及其对PD术后患者结局的影响进行系统评价和荟萃分析。
定义了五个相关的感兴趣结局，并根据PRISMA指南对文献进行了系统评价和荟萃分析。
共纳入28项研究（8523例患者）。胆汁菌血症的中位发生率为58%（四分位间距51%-67%）。最常分离出的细菌是肠球菌属（51%）、克雷伯菌属（28%）和大肠杆菌（27%）。术前胆汁引流与胆汁菌血症显著相关（86%对25%；RR 3.27；95%置信区间（CI）2.42-4.42；p<0.001）。胆汁菌血症患者手术部位感染（SSI）的发生率显著增加（RR 2.84；95%CI 2.17-3.73；p<0.001）。术后胰瘘、总体术后发病率和死亡率未受到显著影响。48%（四分位间距34%-59%）的病例中，胆汁和感染源中的细菌相同。
几乎每例PD术中都能检测到胆汁菌血症，且与SSI发生率增加相关。约50%的患者术中胆汁和术后感染源的微生物组匹配，这为早期给予精准抗生素及确定耐药模式提供了可能。
