title: Five days of postoperative antimicrobial therapy decreases infectious complications following pancreaticoduodenectomy in patients at risk for bile contamination.
abstract: OBJECTIVE
  Pancreaticoduodenectomy (PD) is associated with high morbidity, in part as a result of infectious complications increased by preoperative bile contamination. The aim of the present study was to assess the effect on the incidence of infectious complications of short-term antimicrobial therapy (AMT) in high-risk patients.
  
  
  METHODS
  Patients with a high risk for positive intraoperative bile culture (i.e. those with ampulloma or pancreatic adenocarcinoma with preoperative endoscopic procedures) (high-risk group, n = 99) were compared with low-risk patients (i.e. those with pancreatic adenocarcinoma without preoperative endoscopic procedures) (low-risk group, n = 76). The high-risk group received a 5-day course of perioperative AMT secondarily adapted to the bile antibiogram. The low-risk group received only the usual antimicrobial prophylaxis.
  
  
  RESULTS
  Positive bile cultures were significantly more frequent in high-risk patients (81% versus 12%; P < 0.001). The overall rate of infectious complications was lower in the high-risk group (29% versus 46%; P = 0.018). The statistically significant decrease in the rate of infectious complications reflected reduced rates of urinary tract infections, pulmonary infections and septicaemia. Rates of wound infection (3% versus 5%; P = 0.639) and intra-abdominal abscess (7% versus 7%; P = 0.886) were similar in the high- and low-risk groups, as was the need for curative AMT.
  
  
  CONCLUSIONS
  This exploratory study suggests that a postoperative short course of AMT in patients at high risk for biliary contamination reduces the overall rate of infectious complications after PD. The adaptation of perioperative antimicrobial policy to the patient's risk for bile contamination seems promising and should be further evaluated.
authors: Department of Hepatobiliary and Pancreatic Surgery, Centre for Digestive System Diseases, Beaujon Hospital AP-HP (Assistance-Publique-Hôpitaux de Paris), Clichy.
authors: Isabelle
authors: I
authors: Sourrouille
authors: Sebastien
authors: S
authors: Gaujoux
authors: Guillaume
authors: G
authors: Lacave
authors: François
authors: F
authors: Bert
authors: Safi
authors: S
authors: Dokmak
authors: Jacques
authors: J
authors: Belghiti
authors: Catherine
authors: C
authors: Paugam-Burtz
authors: Alain
authors: A
authors: Sauvanet
mesh_terms: D018784:Abdominal Abscess / Q000382:microbiology / Q000517:prevention & control; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D001646:Bile / Q000382:microbiology*; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012141:Respiratory Tract Infections / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000382:microbiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000890:Anti-Infective Agents