Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
Surgery. 2024 Oct;176(4):1162-1168. doi: 10.1016/j.surg.2024.03.025. Epub 2024 May 19.
Pancreaticoduodenectomy can entail a high complication rate, especially in patients who underwent preoperative bile duct drainage through bile duct stenting. Pancreaticoduodenectomy bile duct stenting patients frequently receive prophylactic antibiotic therapy in the postoperative period. However, the exact value and the benefit of prophylactic antibiotic therapy in pancreaticoduodenectomy bile duct stenting patients remains under-investigated and thus unclear.
We conducted a retrospective single-center study of pancreaticoduodenectomy bile duct stenting patients between January 2007 and December 2022. Demographic, clinical, laboratory, and pathology data of 370 patients were collected, and intraoperative swab cultures of the bile were obtained from all patients upon transection of the common bile duct. The groups to be investigated were formed on the basis of postoperative antibiotic prophylaxis. Postoperative complications and antibiotic resistance analysis were recorded.
Postoperative antibiotic prophylaxis in stented patients after pancreaticoduodenectomy significantly reduced major complications (odds ratio: 0.547 [95% confidence interval 0.327-0.915]; P = .02) such as reoperation (P = .041) and readmission to the intensive care unit (P = .037). Patients with Enterococcus faecalis (odds ratio: 1.699 [95% confidence interval 0.978-2.950];P = .048), Enterococcus faecium (odds ratio: 1.808 [95% confidence interval 1.001-3.264]; P = .050), or Citrobacter (odds ratio: 2.211 [95% confidence interval 1.087-4.497]; P = .029) in their bile had a higher probability of developing wound infections. Appropriate antibiotic prophylaxis, according to the bile duct microbiome, significantly reduced the risk of wound infection (odds ratio: 2.239 [95% confidence interval 1.167-4.298]; P = .015).
Postoperative antibiotic prophylaxis in pancreaticoduodenectomy bile duct stenting patients significantly reduced major complications such as intensive care stay and reoperation. Targeted antibiotic treatment according to the biliary microbiome reduced the incidence of wound infections.
胰十二指肠切除术可能会导致高并发症发生率，尤其是在接受术前胆管引流的患者中。胰十二指肠切除术胆管支架置入患者在术后期间经常接受预防性抗生素治疗。然而，预防性抗生素治疗在胰十二指肠切除术胆管支架置入患者中的确切价值和益处尚未得到充分研究，因此尚不清楚。
我们进行了一项回顾性单中心研究，纳入了 2007 年 1 月至 2022 年 12 月期间接受胰十二指肠切除术胆管支架置入的患者。收集了 370 例患者的人口统计学、临床、实验室和病理数据，并在切断胆总管时从所有患者的胆汁中获得了术中拭子培养物。根据术后抗生素预防情况将患者分为不同的组。记录术后并发症和抗生素耐药性分析。
胰十二指肠切除术后胆管支架置入患者的术后抗生素预防显著降低了主要并发症的发生率（优势比：0.547 [95%置信区间 0.327-0.915]；P=.02），如再次手术（P=.041）和入住重症监护病房（P=.037）。胆汁中检出粪肠球菌（优势比：1.699 [95%置信区间 0.978-2.950]；P=.048）、屎肠球菌（优势比：1.808 [95%置信区间 1.001-3.264]；P=.050）或柠檬酸杆菌（优势比：2.211 [95%置信区间 1.087-4.497]；P=.029）的患者发生伤口感染的概率更高。根据胆管微生物组进行适当的抗生素预防可显著降低伤口感染的风险（优势比：2.239 [95%置信区间 1.167-4.298]；P=.015）。
胰十二指肠切除术胆管支架置入患者的术后抗生素预防显著降低了重症监护病房入住时间和再次手术等主要并发症的发生率。根据胆汁微生物组进行靶向抗生素治疗可降低伤口感染的发生率。
