Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Department of General, Visceral and Thoracic Surgery, St. Elisabethen-Klinikum Ravensburg, Academic Teaching Hospital of the University of Ulm, Elisabethenstr. 15, 88212, Ravensburg, Germany.
Langenbecks Arch Surg. 2022 Nov;407(7):2777-2788. doi: 10.1007/s00423-022-02559-9. Epub 2022 Jun 2.
Septic complications after pancreatic surgery are common. However, it remains unclear if and how a shift of the microbiological spectrum affects morbidity. The aim of the present study was to assess the microbiological spectrum and antibiotic resistance patterns and their impact on outcome.
We conducted a retrospective study including patients undergoing pancreatic surgery at our center between 2005 and 2018. A systematic literature review and descriptive meta-analysis of the published and original data was performed according to the PRISMA guidelines.
A total of 318 patients were included in the analysis. Patients with biliary drainage had a significantly higher incidence of bacterobilia (93% vs. 25%) and received preoperative antibiotics (46% vs. 12%). The analyzed bile cultures showed no resistance to piperacillin/tazobactam, fluoroquinolones, or carbapenems. Resistance to cefuroxime was seen in 58% of the samples of patients without biliary drainage (NBD) and 93% of the samples of those with drainage (BD). In general, there was no significant difference in overall postoperative morbidity. However, superficial surgical site infections (SSIs) were significantly more common in the BD group. We included a total of six studies and our own data (1627 patients) in the descriptive meta-analysis. The percentage of positive bile cultures ranged from 53 to 81%. In patients with BD, the most frequent microorganisms were Enterococcus spp. (58%), Klebsiella spp. (29%), and E. coli (27%). Almost all studies demonstrated resistance to first- and second-generation cephalosporins and to third- and fourth-generation cephalosporins for patients with BD.
A change in perioperative antibiotic strategy according to local resistance patterns, especially after BD, might be useful for patients undergoing pancreatic surgery. Appropriate perioperative antibiotic coverage may help to prevent abdominal infectious complications and especially superficial SSIs.
胰腺手术后发生脓毒症并发症较为常见。但目前仍不清楚微生物谱的变化是否以及如何影响发病率。本研究旨在评估微生物谱和抗生素耐药模式及其对预后的影响。
我们进行了一项回顾性研究，纳入了 2005 年至 2018 年期间在我们中心接受胰腺手术的患者。根据 PRISMA 指南对已发表和原始数据进行了系统的文献复习和描述性荟萃分析。
共纳入 318 例患者进行分析。有胆汁引流的患者菌血症发生率显著更高（93% vs. 25%），且术前使用抗生素的比例更高（46% vs. 12%）。分析的胆汁培养显示，对哌拉西林/他唑巴坦、氟喹诺酮类或碳青霉烯类药物无耐药性。无胆汁引流（NBD）患者的标本中，头孢呋辛耐药率为 58%，而有胆汁引流（BD）患者的标本中耐药率为 93%。总体而言，术后总并发症发生率无显著差异。但 BD 组的浅表手术部位感染（SSI）更为常见。我们纳入了 6 项研究和我们自己的数据（1627 例患者）进行描述性荟萃分析。阳性胆汁培养的比例为 53%至 81%。BD 患者中，最常见的微生物为肠球菌属（58%）、克雷伯菌属（29%）和大肠杆菌（27%）。几乎所有研究均显示，BD 患者对第一代和第二代头孢菌素以及第三代和第四代头孢菌素均耐药。
根据当地耐药模式，特别是在有胆汁引流的患者中，改变围手术期抗生素策略可能对接受胰腺手术的患者有益。适当的围手术期抗生素覆盖可能有助于预防腹部感染性并发症，特别是浅表性 SSI。
