Journal article
Association Between Biliary Pathogens, Surgical Site Infection, and Pancreatic Fistula: Results of a Randomized Trial of Perioperative Antibiotic Prophylaxis in Patients Undergoing Pancreatoduodenectomy
Annals of surgery, Vol.278(3), pp.310-319
09/2023
DOI: 10.1097/SLA.0000000000005955
PMCID: PMC10838195
PMID: 37314221
Abstract
OBJECTIVE Establish the association between bactibilia and postoperative complications when stratified by perioperative antibiotic prophylaxis. BACKGROUND Patients undergoing pancreatoduodenectomy (PD) experience high rates of surgical site infection (SSI) and clinically relevant postoperative pancreatic fistula (CR-POPF). Contaminated bile is known to be associated with SSI, but the role of antibiotic prophylaxis in mitigation of infectious risks is ill-defined. METHODS Intraoperative bile cultures (IOBC) were collected as an adjunct to a randomized phase 3 clinical trial comparing piperacillin-tazobactam with cefoxitin as perioperative prophylaxis in patients undergoing PD. After complication of IOBC data, associations between culture results, SSI, and CR-POPF were assessed using logistic regression stratified by the presence of a preoperative biliary stent. RESULTS Of 778 participants in the clinical trial, IOBC were available for 247 participants. Overall, 68 (27.5%) grew no organisms, 37 (15.0%) grew one organism, and 142 (57.5%) were polymicrobial. Organisms resistant to cefoxitin but not piperacillin-tazobactam were present in 95 patients (45.2%). The presence of cefoxitin-resistant organisms, 92.6% of which contained either Enterobacter or Enterococcus species, was associated with development of SSI in participants treated with cefoxitin (53.5% vs 25.0%; OR 3.44, 95%CI 1.50-7.91; P=0.004) but not those treated with piperacillin-tazobactam (13.5% vs 27.0%; OR 0.42, 95%CI 0.14-1.29; P=0.128). Similarly, cefoxitin-resistant organisms were associated with CR-POPF in participants treated with cefoxitin (24.1% vs 5.8%; OR 3.45, 95%CI 1.22-9.74; P=0.017) but not those treated with piperacillin-tazobactam (5.4% vs 4.8%; OR 0.92, 95%CI 0.30-2.80; P=0.888). CONCLUSION Previously observed reductions in SSI and CR-POPF in patients that received piperacillin-tazobactam antibiotic prophylaxis are potentially mediated by biliary pathogens that are cefoxitin resistant, specifically Enterobacter spp and Enterococcus spp.
Details
- Title: Subtitle
- Association Between Biliary Pathogens, Surgical Site Infection, and Pancreatic Fistula: Results of a Randomized Trial of Perioperative Antibiotic Prophylaxis in Patients Undergoing Pancreatoduodenectomy
- Creators
- Ryan J Ellis - American College of SurgeonsBrian C Brajcich - American College of SurgeonsKimberly A Bertens - University of OttawaCarlos H F Chan - University of IowaCarlos Fernandez-Del Castillo - Massachusetts General HospitalPaul J Karanicolas - University of TorontoShishir K Maithel - Emory University HospitalBradley N Reames - University of Nebraska Medical CenterSharon M Weber - University of Wisconsin–MadisonRoberto J Vidri - University of Wisconsin–MadisonHenry A Pitt - Rutgers, The State University of New JerseyVanessa M Thompson - American College of SurgeonsMithat Gonen - Memorial Sloan Kettering Cancer CenterSusan K Seo - Memorial Sloan Kettering Cancer CenterAdam C Yopp - The University of Texas Southwestern Medical CenterClifford Y Ko - University of California, Los AngelesMichael I D'Angelica - Memorial Sloan Kettering Cancer Center
- Resource Type
- Journal article
- Publication Details
- Annals of surgery, Vol.278(3), pp.310-319
- DOI
- 10.1097/SLA.0000000000005955
- PMID
- 37314221
- PMCID
- PMC10838195
- NLM abbreviation
- Ann Surg
- ISSN
- 0003-4932
- eISSN
- 1528-1140
- Language
- English
- Electronic publication date
- 06/14/2023
- Date published
- 09/2023
- Academic Unit
- Surgery; Radiation Oncology
- Record Identifier
- 9984435247502771
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