新辅助化疗治疗胰腺癌和胆道微生物组的变化。
Neoadjuvant chemotherapy for pancreatic cancer and changes in the biliary microbiome.
机构信息
Department of Surgery, Emory University, Atlanta, GA, USA.
Department of Medicine, Emory University, Atlanta, GA, USA.
出版信息
Am J Surg. 2021 Jul;222(1):3-7. doi: 10.1016/j.amjsurg.2020.09.042. Epub 2020 Oct 5.
BACKGROUND
The use of neoadjuvant chemotherapy (NAC) for pancreatic ductal adenocarcinoma (PDAC) has increased in recent years. Limited data exists on the impact of NAC on biliary microbiome.
METHODS
Patients who underwent pancreaticoduodenectomy (PD) for PDAC between 2014 and 2017 were reviewed. Patients were stratified into two groups based on their NAC status for comparison.
RESULTS
Of 168 patients included, 63 (37.5%) received NAC. Patients who received NAC exhibited significantly increased growth of Gram-negative anaerobic bacteria (p = 0.043). Patients in the non-NAC group were more likely to grow pathogens resistant to ampicillin-sulbactam (47% vs 21%, p = 0.007), cefazolin (49% vs 28%, p = 0.040), cefoxitin (42% vs 11%, p = 0.009) and cefuroxime (26% vs 4%, p = 0.019). NAC status did not impact infectious postoperative outcomes, including SSIs.
CONCLUSION
Patients who did not receive NAC were more likely to grow pathogens resistant to cephalosporins. Perioperative antibiotic prophylaxis should be tailored to cover Gram-negative organisms and enterococci.
背景
近年来，新辅助化疗（NAC）在胰腺导管腺癌（PDAC）中的应用有所增加。关于 NAC 对胆道微生物组影响的数据有限。
方法
回顾了 2014 年至 2017 年间接受胰十二指肠切除术（PD）治疗的 PDAC 患者。根据 NAC 状态将患者分为两组进行比较。
结果
在纳入的 168 例患者中，63 例（37.5%）接受了 NAC。接受 NAC 的患者革兰氏阴性厌氧菌的生长显著增加（p=0.043）。非 NAC 组的患者更有可能生长对氨苄西林-舒巴坦（47%比 21%，p=0.007）、头孢唑林（49%比 28%，p=0.040）、头孢西丁（42%比 11%，p=0.009）和头孢呋辛（26%比 4%，p=0.019）耐药的病原体。NAC 状态并不影响包括手术部位感染在内的术后感染性结局。
结论
未接受 NAC 的患者更有可能生长对头孢菌素耐药的病原体。围手术期抗生素预防应针对革兰氏阴性菌和肠球菌。
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