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Utility of intraoperative bile duct cultures to predict postoperative infectious complications following pancreaticoduodenectomy
*Raphael J Louie1, *Maija S Cheung2, *Ian C Bostock Rosenzweig1, *Stuart R Gordon1, *Timothy B Gardner1, John E Sutton, Jr1, Thomas A Colacchio1, Richard J Barth, Jr1, Kerrington D Smith1
1Dartmouth-Hitchcock Medical Center, Lebanon, NH;2Yale-New Haven Hospital, New Haven, CT

Objective: We aim to determine whether the presence of bacterobilia at the time of surgery is associated with an increased incidence of infectious complications following pancreaticoduodenectomy.
Design: Single institution retrospective cohort study.
Setting: Tertiary care referral center.
Patients: Patients undergoing pancreaticoduodenectomy with intraoperative bile duct cultures from September 1, 2009 to December 31, 2013
Interventions: During pancreaticoduodenectomy, bile was swab-cultured at the time of bile duct transection and sent to microbiology for gram staining with aerobic/anaerobic culturing.
Main Outcome Measure(s): Incidence of bacterobilia, surgical site infections (superficial and deep) and corresponding antimicrobial sensitivities.
Results: 76 patients underwent pancreaticoduodenectomy with bile duct cultures obtained at the time of surgery, of which 43 patients had indwelling preoperative endobiliary stents. 66 patients (86.8%) received ampicillin-sulbactam for antibiotic prophylaxis. Bacterobilia was present in 44 patients (57.9%), including 36 patients with preoperative endobiliary stents (83.7%). 6 patients (13.6%) grew organisms resistant to perioperative ampicillin-sulbactam. Overall, 34 patients (43.0%) developed postoperative infections (18 superficial, 9 deep, 7 both). 15 out of 44 patients (34.1%) with positive bile duct cultures developed postoperative infectious complications (p = 0.107). The presence of a biliary stent was associated with a positive intraoperative bile duct culture (p < 0.001) and the development of a postoperative infectious complication (p = 0.044).
Conclusions: Bacterobilia was found in 57.9% of patients undergoing pancreaticoduodenectomy. The presence of an endobiliary stent was significantly associated with bacterobilia and an increased risk for developing a postoperative infection. Although positive intraoperative bile duct culture was not significantly associated with infectious complications, the antibiotic sensitivities and resistance patterns may provide valuable intraoperative microbiology surveillance to inform intrahospital antibiotic nomograms for perioperative antibiotic selection.


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