title: Bile cultures: a guide to infectious complications after pancreaticoduodenectomy.
abstract: BACKGROUND
  The aim of this study was to evaluate the utility of intraoperative bile cultures on the outcome of patients undergoing pancreaticoduodenectomy.
  
  
  METHODS
  A review of a hepato-pancreato-biliary database was performed to identify all patients who had a pancreaticoduodenectomy from 1/1998 to 8/2008.
  
  
  RESULTS
  Two hundred twenty-eight patients were evaluated, with preoperative biliary stenting performed in 129 out of 229 patients (57%), with 63/129(49%) had bile cultures taken intraoperatively, 39/129(30%) having positive bile cultures. Neither preoperative biliary stenting (incidence of complication: 54% with stent vs. 51% without, P = 0.9) nor positive bile culture (incidence of complication: 54% with positive bile culture vs. 53% without, P = 0.9) were predictors of overall complications. Length of operating time, length of hospital stay, blood loss, blood transfusion, and severity of complications were similar in the group with and without stent. There were 19 different organisms identified with not a single species was a statistically significant predictor of neither severity of complication nor increased length of stay.
  
  
  CONCLUSIONS
  Preoperative biliary stenting correlates with similar rate of biliary infections, however, intraoperative bile culture allows for early appropriate antibiotic use, which maintains a similar morbidity and infectious incidence as in patients without stents.
authors.affiliation: Division of Surgical Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA.
authors.forename: Vedra A
authors.initials: VA
authors.lastname: Augenstein
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Reuter
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Bower
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000382:microbiology*; D001660:Biliary Tract Diseases / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology*; D011446:Prospective Studies; D015607:Stents / Q000382:microbiology; D016896:Treatment Outcome