title: The Impact of Bile Duct Cultures on Surgical Site Infections in Pancreatic Surgery.
abstract: BACKGROUND
  In pancreatic surgery pre-operative biliary drainage (PBD) is associated with bacteribilia, which increases the risk for surgical site infections (SSIs).
  
  
  METHODS
  This study is a retrospective observational cohort design that compared micro-organisms of intra-operative bile duct cultures with micro-organisms of SSIs after pancreaticoduodenectomy.
  
  
  RESULTS
  From January 2004 until December 2010, 887 patients underwent pancreaticoduodenectomy or hepaticojejunostomy for benign and malignant peri-ampullary lesions. Surgical site infections occurred in 10% (87/887). Cultures of SSIs with corresponding intra-operative bile duct cultures were available for 59 patients. Sixty-four percent (38/59) had undergone PBD. Pre-operative biliary drainage was associated with positive intra-operative bile duct cultures in 95% (36/38), versus 48% (10/21; p≤0.001). The correlation of SSIs with intra-operative bile duct cultures was 59% (35/59). There was a significant association between the micro-organisms cultured from SSIs and the corresponding bile duct cultures for Enterococcus spp., Escherichia coli, Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA), Enterobacteriaceae with extended spectrum ß-lactamase (ESBL), and Candida spp.
  
  
  CONCLUSIONS
  After pancreaticoduodenectomy, SSIs are often caused by the same micro-organisms that are present on intra-operative bile duct cultures, especially after PBD. Therefore, intra-operative bile duct cultures should be performed routinely to adjust the antibiotic prophylaxis according to the local hospital surveillance data.
authors.affiliation: Department of Surgery, St. Josef Hospital, Ruhr University Bochum , Germany .
authors.forename: Torsten
authors.initials: T
authors.lastname: Herzog
authors.affiliation: Department of Surgery, St. Josef Hospital, Ruhr University Bochum , Germany .
authors.forename: Orlin
authors.initials: O
authors.lastname: Belyaev
authors.affiliation: Department of Surgery, St. Josef Hospital, Ruhr University Bochum , Germany .
authors.forename: Rehsan
authors.initials: R
authors.lastname: Akkuzu
authors.affiliation: Department of Surgery, St. Josef Hospital, Ruhr University Bochum , Germany .
authors.forename: Janine
authors.initials: J
authors.lastname: Hölling
authors.affiliation: Department of Surgery, St. Josef Hospital, Ruhr University Bochum , Germany .
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
authors.affiliation: Department of Surgery, St. Josef Hospital, Ruhr University Bochum , Germany .
authors.forename: Ansgar M
authors.initials: AM
authors.lastname: Chromik
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D001652:Bile Ducts / Q000382:microbiology*; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology*