Pôle d'anesthésie-réanimation, CHU de Lille, 59000 Lille, France; Inserm, CNRS, institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, University Lille, 59000 Lille, France.
Pôle d'anesthésie-réanimation, CHU de Lille, 59000 Lille, France.
Infect Dis Now. 2021 Aug;51(5):456-463. doi: 10.1016/j.idnow.2021.01.001. Epub 2021 Jan 9.
Postoperative infections occur frequently after pancreaticoduodenectomy, especially in patients with bile colonization. Recommendations for perioperative anti-infectious treatment are lacking, and clinical practice is heterogenous. We have analyzed the effects of bile colonization and antibiotic prophylaxis on postoperative infection rates, types and therapeutic consequences.
Retrospective observational study in patients undergoing pancreaticoduodenectomy with intraoperative bile culture. Data on postoperative infections and non-infectious complications, bile cultures and antibiotic prophylaxis adequacy to biliary bacteria were collected.
Among 129 patients, 53% had a positive bile culture and 23% had received appropriate antibiotic prophylaxis. Postoperative documented infection rate was over 40% in patients with or without bile colonization, but antibiotic therapy was more frequent in positive bile culture patients (77% vs. 57%, P=0,008). The median duration of antibiotic therapy was 11 days and included a broad-spectrum molecule in 42% of cases. Two-thirds of documented postoperative infections involved one or more bacteria isolated in bile cultures, which was associated with a higher complication rate. While bile culture yielded Gram-negative bacilli (57%) and Gram-positive cocci (43%), fungal microorganisms were scarce. Adequate preoperative antibiotic prophylaxis according to bile culture was not associated with reduced infectious or non-infectious complication rates.
Patients undergoing pancreaticoduodenectomy experience a high rate of postoperative infections, often involving bacteria from perioperative bile culture when positive, with no preventive effect of an adequate preoperative antibiotic prophylaxis. Increased postoperative complications in patients with bile colonization may render necessary a perioperative antibiotic treatment targeting bile microorganisms. Further prospective studies are needed to improve the anti-infectious strategy in these patients.
胰十二指肠切除术后常发生术后感染，尤其是在胆汁定植的患者中。围手术期抗感染治疗的建议缺乏，临床实践存在异质性。我们分析了胆汁定植和抗生素预防对术后感染率、类型和治疗后果的影响。
对术中胆汁培养的胰十二指肠切除术患者进行回顾性观察性研究。收集术后感染和非感染性并发症、胆汁培养和抗生素预防对胆汁细菌的充分性的数据。
在 129 例患者中，53%的患者胆汁培养阳性，23%的患者接受了适当的抗生素预防。有或没有胆汁定植的患者术后有记录的感染率超过 40%，但阳性胆汁培养患者的抗生素治疗更为频繁（77%比 57%，P=0.008）。抗生素治疗的中位数持续时间为 11 天，42%的病例包括广谱分子。有记录的术后感染中有三分之二涉及胆汁培养中分离出的一种或多种细菌，这与更高的并发症发生率相关。虽然胆汁培养产生了革兰氏阴性杆菌（57%）和革兰氏阳性球菌（43%），但真菌微生物很少。根据胆汁培养进行适当的术前抗生素预防与降低感染或非感染性并发症发生率无关。
接受胰十二指肠切除术的患者术后感染率较高，常涉及阳性胆汁培养中的细菌，术前适当的抗生素预防无预防作用。胆汁定植患者术后并发症增加可能需要针对胆汁微生物进行围手术期抗生素治疗。需要进一步的前瞻性研究来改善这些患者的抗感染策略。
