title: Perioperative antibiotics covering bile contamination prevent abdominal infectious complications after pancreatoduodenectomy in patients with preoperative biliary drainage.
abstract: BACKGROUND
  Although bile contamination caused by preoperative biliary drainage (PBD) is a risk factor for infectious complications after pancreatoduodenectomy, the appropriate perioperative antibiotic regimen remains unclear. We evaluated a perioperative antibiotic strategy targeting bile contamination associated with PBD procedures for preventing abdominal infectious complications after pancreatoduodenectomy.
  
  
  METHODS
  Consecutive patients (n = 254) underwent pancreatoduodenectomy at a single center. Perioperative antibiotics were mainly cefazolin in non-PBD cases (n = 116) and cefozopran in internal-PBD cases (n = 87). They were based on preoperative bile cultures in 51 of the external-PBD cases. Intraoperative bile cultures were examined prospectively. Morbidity and abdominal infectious complication rates were evaluated.
  
  
  RESULTS
  The incidence of positive intraoperative bile cultures was significantly higher in the internal-PBD (85 %) and external-PBD (90 %) cases than in the non-PBD cases (26 %) (p < 0.001). The 91 % susceptibility to cefazolin for non-PBD was significantly higher than the 61 % for internal-PBD or 45 % for external-PBD (p < 0.001). Overall morbidity rates (23, 23, and 25 %) and abdominal infectious complications (13, 17, and 14 %) did not differ among the non-PBD, internal-PBD, and external-PBD cases, respectively. Only susceptibility to perioperative antibiotics of biliary microorganisms classified as resistant was a significant independent risk factor for abdominal infectious complications (p = 0.003).
  
  
  CONCLUSIONS
  A perioperative antibiotic strategy particular to PBD procedures is valid for covering biliary microorganisms during pancreatoduodenectomy. Perioperative antibiotics covering bile contamination may prevent abdominal infectious complications after pancreatoduodenectomy in patients with and without PBD.
authors.affiliation: Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan, tsudo@hiroshima-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sudo
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Murakami
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Uemura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Naru
authors.initials: N
authors.lastname: Kondo
authors.forename: Naoya
authors.initials: N
authors.lastname: Nakagawa
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ohge
authors.forename: Taijiro
authors.initials: T
authors.lastname: Sueda
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001646:Bile / Q000382:microbiology; D002437:Cefazolin / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D015169:Colony Count, Microbial; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011300:Preoperative Care / Q000009:adverse effects; D011446:Prospective Studies; D000097586:Cefozopran
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin; D002511:Cephalosporins; D000097586:Cefozopran