title: Bacteribilia with resistant microorganisms after preoperative biliary drainage--the influence of bacteria on postoperative outcome.
abstract: BACKGROUND
  In pancreatic surgery, preoperative biliary drainage (PBD) leads to bacteribilia. Whether positive bile duct cultures are associated with a higher postoperative morbidity might be related to the resistance of the species isolated from bile.
  
  
  METHODS
  Intraoperative bile duct cultures were collected from all patients who underwent pancreatic surgery. Postoperative morbidity was analyzed according to the species and the resistance found on bile duct cultures.
  
  
  RESULTS
  Fifty-five percent (166/301) of patients had PBD, while 45% (135/301) underwent primary operation. PBD was associated with a positive bile duct culture in 87% (144/166) versus 21% (28/135) in patients without PBD (p = 0.001) and polymicrobial infections in 53% (88/166) versus 6% (8/135) (p = 0.001). Postoperative morbidity was 40% (121/301); mortality was 3% (9/301). PBD was not associated with morbidity and mortality, but resistant species on bile duct cultures lead to significantly more postoperative complications, 54% (25/46) versus 38% (96/255) (p = 0.033), with significantly more antibiotic therapies.
  
  
  CONCLUSIONS
  PBD is associated with polymicrobial infections with resistant microorganisms, resulting in more postoperative complications. Since PBD cannot always be avoided, surgeons and gastroenterologists must be aware of their institutional surveillance data to identify patients at risk for postoperative complications.
authors.affiliation: Department of Surgery, St. Josef Hospital, Ruhr-University Bochum, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Herzog
authors.forename: Orlin
authors.initials: O
authors.lastname: Belyaev
authors.forename: Schapoor
authors.initials: S
authors.lastname: Hessam
authors.forename: Dominique
authors.initials: D
authors.lastname: Suelberg
authors.forename: Monika
authors.initials: M
authors.lastname: Janot
authors.forename: Henning
authors.initials: H
authors.lastname: Schrader
authors.forename: Wolfgang E
authors.initials: WE
authors.lastname: Schmidt
authors.forename: Agnes
authors.initials: A
authors.lastname: Anders
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
authors.forename: Christophe A
authors.initials: CA
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001652:Bile Ducts / Q000382:microbiology*; D016009:Chi-Square Distribution; D002761:Cholangitis / Q000382:microbiology; D003422:Critical Care; D004322:Drainage / Q000009:adverse effects*; D024901:Drug Resistance, Multiple, Bacterial; D016984:Enterococcus faecium; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery; D011300:Preoperative Care / Q000009:adverse effects*; D012086:Reoperation; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology*; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents