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. 2023 Apr;30(4):514-522.
doi: 10.1002/jhbp.1214. Epub 2022 Jul 15.

Cefotaxime resistance in bile samples is an independent predictor of deep infectious complications after pancreaticoduodenectomy in patients with endoprosthesis

Fabien Robin  1   2 , Marie Livin  1 , Damien Bergeat  1 , Haitham Triki  1 , Elodie Gaignard  1 , Marine Cailleaux  3 , Vincent Cattoir  4 , Karim Boudjema  1   5 , Pierre Tattevin  3 , Laurent Sulpice  1   2
Affiliations

Cefotaxime resistance in bile samples is an independent predictor of deep infectious complications after pancreaticoduodenectomy in patients with endoprosthesis

Fabien Robin et al. J Hepatobiliary Pancreat Sci. 2023 Apr.

Abstract

Background: Bacteriobilia may increase the rate of deep infectious complications (DIC) after pancreaticoduodenectomy. To better adjust prophylactic and empirical antibacterial treatment, we aimed to characterize bacteriobilia in patients with preoperative endoprosthesis, and its association with postoperative DIC.

Methods: All patients who underwent pancreaticoduodenectomy in our center between 2010 and 2019 were included. The association between microbiological findings from bile samples, and postoperative DIC was analyzed, and we compared microbiology data between 2010-2014 and 2015-2019 periods.

Results: We enrolled 578 patients (median age 67 years [59-72], 58.7% males), of whom 220 (38.1%) had preoperative biliary endoprosthesis, with 197 (89.5%) positive preoperative bile samples pathogens were Enterobacterales, enterococci, and Candida albicans. The incidence of DIC was similar in patients with or without endoprosthesis (20.4% vs 17.8%, P = .352). Bacterial isolates collected during 2015-2019 were more resistant to cefotaxime than those recovered from 2010-2014 (45.5% vs 25.5%, P = .009). The only independent risk factor for DIC in patients with endoprosthesis was cefotaxime resistance in bile (hazard ratio 3.027 [1.115-8.216], P = .03).

Conclusions: The incidence of DIC is high after pancreaticoduodenectomy, with or without endoprosthesis, despite routine postoperative treatment. Cefotaxime resistance, the only independent predictor of DIC in patients with endoprosthesis, has increased over time. Hence, cefotaxime may no longer be an appropriate empirical treatment.

Keywords: bacteriobilia; complications; endoprosthesis; infection; pancreatoduodenectomy.

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References

REFERENCES

    1. Pastena MD, Paiella S, Marchegiani G, Malleo G, Ciprani D, Gasparini C, et al. Postoperative infections represent a major determinant of outcome after pancreaticoduodenectomy: results from a high-volume center. Surgery. 2017;162:792-801.
    1. Sauvanet A, Boher J-M, Paye F, Bachellier P, Sa Cuhna A, Le Treut Y-P, et al. Severe jaundice increases early severe morbidity and decreases long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. J Am Coll Surg. 2015;221:380-9.
    1. Cortes A, Sauvanet A, Bert F, Janny S, Sockeel P, Kianmanesh R, et al. Effect of bile contamination on immediate outcomes after pancreaticoduodenectomy for tumor. J Am Coll Surg. 2006;202:93-9.
    1. Ohgi K. Bacterobilia may trigger the development and severity of pancreatic fistula after pancreatoduodenectomy. Surgery. 2016;6:725-30.
    1. Fujii T, Yamada S, Suenaga M, Kanda M, Takami H, Sugimoto H, et al. Preoperative internal biliary drainage increases the risk of bile juice infection and pancreatic fistula after pancreatoduodenectomy: a prospective observational study. Pancreas. 2015;44:465-70.

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