Risk of postoperative infection in patients with bactibilia undergoing surgery for obstructive jaundice.
BACKGROUND
This study was performed to investigate the relationship between bactibilia and postoperative infection in patients undergoing surgery for obstructive jaundice.


METHODS
With IRB approval, we prospectively examined 76 patients undergoing surgery for obstructive jaundice. It was the routine practice of the surgeons performing the operations to culture the common bile duct bile (CBDB). Rates of postoperative infection were analyzed with regard to the effect of positive bile cultures and biliary instrumentation preoperatively.


RESULTS
Seventy-one patients had CBDB cultures, 16 of whom had bactibilia. Bactibilia was present in 15 of 47 (33%) who had preoperative ERCP versus one of 24 (4%) of those without preoperative ERCP (p = 0.0075). Postoperative infection, including pneumonia, bloodstream, central venous catheter, surgical site, intraabdominal, and urinary tract infection, occurred in six of 16 (38%) of those with bactibilia versus four of 55 (7%) of those without bactibilia (p = 0.0071).


CONCLUSIONS
Preoperative ERCP was associated with an approximately eightfold increase in the likelihood of having culture-positive bile at the time of surgery for obstructive jaundice. Additionally, culture-positive bile at the time of surgery was associated with a greater than fivefold incidence of postoperative infection.
Namias
Nicholas
N
Miller School of Medicine Department of Surgery, University of Miami, Miami, Florida 33101, USA. nnamias@miami.edu
Demoya
Marc
M
Sleeman
Danny
D
Reever
Carolyn M
CM
Raskin
Jeffrey B
JB
Ginzburg
Enrique
E
Minhaj
Mohammed
M
Pappas
Peter A
PA
Padron
Imelda
I
Levi
Joe U
JU
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000382:microbiology*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D003135:Common Bile Duct; D003137:Common Bile Duct Diseases / Q000453:epidemiology* / Q000382:microbiology; D003470:Culture Media; D004755:Enterobacteriaceae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D041781:Jaundice, Obstructive / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors
D003470:Culture Media