Randomized controlled trial of perioperative antimicrobial therapy based on the results of preoperative bile cultures in patients undergoing biliary reconstruction

Okamura, Kunishige; Tanaka, Kimitaka; Miura, Takumi; Nakanishi, Yoshitsugu; Noji, Takehiro; Nakamura, Tõru; Tsuchikawa, Takahiro; Okamura, Keisuke; Shichinohe, Toshiaki; Hirano, Satoshi

doi:10.1002/jhbp.453

Cited by 45 publications

(76 citation statements)

References 33 publications

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“…The proportion of patients in whom A hydrophila was isolated was therefore low compared with other bacteria, such as Enterococcus, Escherichia, Pseudomonas, Klebsiella, and Enterobacter species. 11 As had been previously reported, however, in the current study A hydrophila infection showed potential to develop into lethal POIC. 12 As for surgical procedures, there was no mortality among our patients that underwent cholecystectomy and hepatectomy without biliary reconstruction.…”

Section: Discussionsupporting

confidence: 59%

“…Assessment of bacteria species and their antibiogram spectrum and selecting or combining appropriate antibiotics with consideration of pathogenicity of each bacterium could therefore be important. 11 In this cohort, one patient died due to sepsis, although he had been preoperatively confirmed to have isolation of A hydrophila. Several other major bacteria were confirmed in this case and the appropriate antibiotics for A hydrophila were not chosen.…”

Section: Discussionmentioning

confidence: 83%

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Mortality analysis of Aeromonas hydrophila infection in hepato‐biliary pancreatic surgery: Multicenter retrospective observational study

Ueno

Iida

Kaibori

et al. 2020

J Hepato Biliary Pancreat

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Background/Purpose: Aeromonas hydrophila can cause lethal infectious complications after surgery. There have been no large cohort studies of this specific to the hepato-biliary-pancreatic (HBP) field. We investigate the postoperative influence of A hydrophila infection after HBP surgery. Methods: We retrospectively reviewed patients who underwent HBP surgery between 2008 and 2017 at eight university hospitals. Patients with A hydrophila isolation during perioperative management were extracted, and their postoperative courses were investigated. Results: Bacterial culture examination of 10 074 patients was performed as perioperative management. Among them, 76 patients (0.75%) had A hydrophila isolation, most of whom underwent pancreatoduodenectomy (n = 38) or hepatectomy with biliary reconstruction (n = 14). There were seven mortalities after these two procedures (13.5%), five within 3 days after the onset of infection. Bile (n = 48) and abdominal drainage fluid (n = 29) were major sites of A hydrophila isolation. Typical prophylactic antibiotics, cefazolin or flomoxef, were mostly resistant. There was no mortality among patients that received sensitive antibiotics prophylactically. Conclusions: Isolation of A hydrophila was low in our cases of HBP surgery, but the condition of some patients deteriorated rapidly by this infection. Although there could be several bacterial infections during management of HBP surgery, A hydrophila should not be overlooked. Preparation of appropriate prophylactic antibiotics may prevent or reduce mortality.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 83%

Mortality analysis of Aeromonas hydrophila infection in hepato‐biliary pancreatic surgery: Multicenter retrospective observational study

Ueno

Iida

Kaibori

et al. 2020

J Hepato Biliary Pancreat

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“…Evidence suggests that PBD can improve immune functions and nutritional sta-Early intraabdominal infection following pancreaticoduodenectomy bacterial contamination. A randomized controlled trial conducted by Okamura et al demonstrated that preoperative bile culturetargeted administration of prophylactic antibiotics decreased surgical site infections in hepatobiliarypancreatic surgery with biliary reconstruction 26) .…”

Section: Discussionmentioning

confidence: 99%

Early intra-abdominal infection following pancreaticoduodenectomy:associated factors and clinical impact on surgical outcome

Sato

Kimura

Kenjo

et al. 2020

FJMS

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Early intraabdominal infection (IAI) following pancreaticoduodenectomy (PD) is an initial event relating to morbidities caused by postoperative pancreatic fistula (POPF). The aims of this study were to determine factors associated with IAI, and to investigate its impact on postoperative outcome. Consecutive patients, 113 in total, who underwent PD at Fukushima Medical University Hospital between January 2012 and September 2017 were included in this retrospective study. IAI was defined by positive bacterial culture from intraabdominal drainage fluid any time through postoperative day 3 (POD3). Logistic regression analysis was used to identify the relevant factors associated with IAI. The clinical impact of the POD3 infection indicators related to POPF were assessed by multivariate analysis. The incidence of IAI, POPF, and mortality were 36.1%, 36.1%, and 0%, respectively. Independent factors associated with IAI were preoperative biliary drainage (PBD) (OR=2.91, CI=1.16-7.33, p=0.023) and soft pancreas (OR=8.67, CI=2.37-31.77, p=0.001). Among infection markers on POD3, the significant factors for POPF were CRP (OR=1.18, CI=1.08-1.30, p<0.001), IAI (OR=7,37, CI=2.53-21.5, p<0.001), and drain amylase (OR=1.00, CI=1.00-1.01, p=0.001). In conclusion, PBD, soft pancreas, and higher age were associated with IAI. IAI has a significantly negative impact on postoperative outcome.

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“…In the literature, some descriptions of a higher incidence of liver abscess after biliary-enteric anastomosis [12] , or endoscopic interventions such as papillotomy and stent implantation, have been reported because bacterial invasion of the bile duct may occurr after loss of protection by the papillae [4] . A high frequency of surgical site infections (SSIs) after hepato-pancreatic-biliary (HBP) surgery, including biliary reconstruction, was also reported in a trial of antimicrobial therapy [13] . Because 40% of Japanese cases had HBP surgery with biliary reconstruction, prophylactic antibiotics could be considered to avoid this critical condition, if the patient has other systemic risks.…”

Section: Discussionmentioning

confidence: 95%

Fatal liver gas gangrene after biliary surgery

Miyata

Kashiwagi

Koizumi

et al. 2017

International Journal of Surgery Case Reports

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Randomized controlled trial of perioperative antimicrobial therapy based on the results of preoperative bile cultures in patients undergoing biliary reconstruction

Abstract: This study demonstrated that preoperative bile culture-targeted administration of prophylactic antibiotics decreased SSIs following HBP surgery with biliary reconstruction.

Cited by 45 publications

References 33 publications

Mortality analysis of Aeromonas hydrophila infection in hepato‐biliary pancreatic surgery: Multicenter retrospective observational study

Mortality analysis of Aeromonas hydrophila infection in hepato‐biliary pancreatic surgery: Multicenter retrospective observational study

Early intra-abdominal infection following pancreaticoduodenectomy:associated factors and clinical impact on surgical outcome

Fatal liver gas gangrene after biliary surgery

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