Sutton Thomas L, O'Grady Jack, Martindale Robert, Mayo Skye C, Gilbert Erin W, Sheppard Brett C
Department of Surgery, Oregon Heath & Science University (OHSU), Portland, OR, 97239, USA.
OHSU School of Medicine, Portland, OR, 97239, USA.
J Gastrointest Surg. 2022 Jan;26(1):30-38. doi: 10.1007/s11605-021-05182-z. Epub 2021 Oct 26.
Biliary stents increase surgical site infections (SSIs) following pancreaticoduodenectomy due to bactibilia and contaminated intraoperative bile spillage. Intraoperative bile culture (IOBC) is performed to guide empiric therapy for SSIs; however, its utility is poorly studied. We sought to evaluate IOBC and the interplay between stenting, bactibilia, and SSI following pancreaticoduodenectomy.
Patients undergoing pancreaticoduodenectomy from January 2008 to April 2020 were identified through our institutional National Surgical Quality Improvement Project (NSQIP) database; patients without IOBC were excluded. Odds of SSI were analyzed with multivariable logistic regression.
Four-hundred-eighty-three patients were identified. One-hundred-eighty-nine (39%) patients had plastic stents and 154 (32%) had metal stents. Three-hundred-twenty-nine (96%) patients with stents had bactibilia versus 18 (13%) without stents (P < 0.001). The biliary microbiome and antibiotic resistance patterns in patients with metal and plastic stents were nearly identical. Of 159 NSQIP-defined SSIs, most were incisional (n = 92, 58%). Bactibilia and stent presence were associated with incisional (OR 3.69 and 3.39, both P < 0.001) but not organ space SSI (P > 0.1); however, stent type was not (P > 0.5). Of the 73 speciated SSI cultures, an IOBC-identified organism was present in 42 (58%), while at least one organism not found in the IOBC was present in 49 (67%).
Bactibilia is associated with incisional but not organ space SSI following pancreaticoduodenectomy and is strongly associated with stent presence. Stent type does not independently influence the biliary microbiome or SSI risk. IOBC has a poor ability to predict causative organisms in SSIs following pancreaticoduodenectomy and is not recommended for routine use.
由于胆源性菌血症和术中胆汁污染，胆管支架会增加胰十二指肠切除术后手术部位感染（SSI）的发生率。术中胆汁培养（IOBC）用于指导SSI的经验性治疗；然而，其效用尚未得到充分研究。我们旨在评估IOBC以及胰十二指肠切除术后支架置入、胆源性菌血症和SSI之间的相互作用。
通过我们机构的国家外科质量改进项目（NSQIP）数据库识别2008年1月至2020年4月期间接受胰十二指肠切除术的患者；排除未进行IOBC的患者。采用多变量逻辑回归分析SSI的发生几率。
共识别出483例患者。189例（39%）患者使用塑料支架，154例（32%）患者使用金属支架。329例（96%）有支架的患者发生胆源性菌血症，而无支架的患者中有18例（13%）发生胆源性菌血症（P < 0.001）。金属支架和塑料支架患者的胆汁微生物群和抗生素耐药模式几乎相同。在159例NSQIP定义的SSI中，大多数为切口感染（n = 92，58%）。胆源性菌血症和支架的存在与切口感染相关（OR分别为3.69和3.39，P均 < 0.001），但与器官间隙SSI无关（P > 0.1）；然而，支架类型与切口感染无关（P > 0.5）。在73份明确菌种的SSI培养物中，42份（58%）培养出了IOBC鉴定出的微生物，而49份（67%）培养出了至少一种IOBC未发现的微生物。
胆源性菌血症与胰十二指肠切除术后的切口感染相关，但与器官间隙SSI无关，且与支架的存在密切相关。支架类型不会独立影响胆汁微生物群或SSI风险。IOBC预测胰十二指肠切除术后SSI致病菌的能力较差，不建议常规使用。
