2016
DOI: 10.1001/jamasurg.2015.4510
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Discordance Between Perioperative Antibiotic Prophylaxis and Wound Infection Cultures in Patients Undergoing Pancreaticoduodenectomy

Abstract: The findings of this large-scale, multi-institutional study indicate that intraoperative bile cultures should be routinely obtained in patients who underwent preoperative endoscopic retrograde cholangiopancreatography since the isolated microorganisms closely correlate with those identified on postoperative wound cultures. Institution-specific internal reviews should amend current protocols for antibiotic prophylaxis to reduce the incidence of wound infections following PD.

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Cited by 100 publications
(83 citation statements)
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“…Intraoperative specimen cultures were positive in the majority (96%) of patients, which is significantly higher than the rate of 58–87% reported in the literature . This probably reflects the high prevalence of preoperative biliary stenting in our patient cohort as most of the operative specimens from which cultures were obtained were biliary stents rather than swabs or tissue.…”
Section: Discussioncontrasting
confidence: 50%
See 1 more Smart Citation
“…Intraoperative specimen cultures were positive in the majority (96%) of patients, which is significantly higher than the rate of 58–87% reported in the literature . This probably reflects the high prevalence of preoperative biliary stenting in our patient cohort as most of the operative specimens from which cultures were obtained were biliary stents rather than swabs or tissue.…”
Section: Discussioncontrasting
confidence: 50%
“…Candida species were cultured in half of the patients whilst other studies report a prevalence of Candida species of 0–26% in intraoperative bile specimens . One multicentre retrospective study compared the results of intraoperative bile and surgical site infection cultures from patients undergoing pancreatoduodenectomy at Massachusetts General Hospital in the USA and the University of Verona Hospital in Italy and demonstrated variability in the isolates between centres, although the prevalence of Candida albicans in intraoperative bile cultures was similar at approximately 13% …”
Section: Discussionmentioning
confidence: 99%
“…This is consistent with previous studies that support the utility of prior individual culture data in predicting subsequent antibiotic susceptibility patterns in both medical and Surg Infect (Larchmt). (3941) Knowledge of an individual’s past culture data and related risk for antibiotic-resistant infection is a crucial part of appropriate antibiotic selection for a given patient. (40, 42, 43) A combined approach to SAP based on procedure-specific risks in conjunction with a patient’s own prior culture data could potentially serve to improve clinical outcomes.…”
Section: Discussionmentioning
confidence: 99%
“…Despite the different practice patterns at the 3 institutions whose pancreatic databases were queried by Fong et al, 1 the consistent finding was that intraoperative bile cultures predicted the spectrum of postoperative wound infections. In addition, the therapeutic range of the prophylactic antibiotics used did not correspond to the spectrum of wound infection cultures found at each institution.…”
mentioning
confidence: 99%
“…Despite this, all 3 institutions combined had an acceptably low overall wound infection rate of 8.2%. This study 1 ply to all fields of surgery: institution-specific internal reviews should be undertaken to ensure that the prophylactic antibiotic chosen actually covers the organisms identified in wound infections for that institution. It seems that infections, like politics, are local.…”
mentioning
confidence: 99%