title: Impact of bacterial contamination of the abdominal cavity during pancreaticoduodenectomy on surgical-site infection.
abstract: BACKGROUND
  Several risk factors for complications after pancreaticoduodenectomy have been reported. However, the impact of intraoperative bacterial contamination on surgical outcome after pancreaticoduodenectomy has not been examined in depth.
  
  
  METHODS
  This retrospective study included patients who underwent pancreaticoduodenectomy and peritoneal lavage using 7000 ml saline between July 2012 and May 2014. The lavage fluid was subjected to bacterial culture examination. The influence of a positive bacterial culture on surgical-site infection (SSI) and postoperative course was evaluated. Risk factors for positive bacterial cultures were also evaluated.
  
  
  RESULTS
  Forty-six (21.1 per cent) of 218 enrolled patients had a positive bacterial culture of the lavage fluid. Incisional SSI developed in 26 (57 per cent) of these 46 patients and in 13 (7.6 per cent) of 172 patients with a negative lavage culture (P < 0.001). Organ/space SSI developed in 32 patients with a positive lavage culture (70 per cent) and in 43 of those with a negative culture (25.0 per cent) (P < 0.001). Grade B/C pancreatic fistula was observed in 22 (48 per cent) and 48 (27.9 per cent) respectively of patients with positive and negative lavage cultures (P = 0.010). Postoperative hospital stay was longer in patients with a positive lavage culture (28 days versus 21 days in patients with a negative culture; P = 0.028). Multivariable analysis revealed that internal biliary drainage, combined colectomy and a longer duration of surgery were significant risk factors for positive bacterial culture of the lavage fluid.
  
  
  CONCLUSIONS
  Intraoperative bacterial contamination has an adverse impact on the development of SSI and grade B/C pancreatic fistula following pancreaticoduodenectomy.
authors.affiliation: Divisions of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Sugiura
authors.affiliation: Divisions of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Mizuno
authors.affiliation: Divisions of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Okamura
authors.affiliation: Divisions of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ito
authors.affiliation: Divisions of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Divisions of Infectious Disease, Shizuoka Cancer Centre, Shizuoka, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Kawamura
authors.affiliation: Divisions of Infectious Disease, Shizuoka Cancer Centre, Shizuoka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kurai
authors.affiliation: Divisions of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Centre, Shizuoka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Uesaka
mesh_terms: D034841:Abdominal Cavity / Q000382:microbiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010533:Peritoneal Lavage / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D015996:Survival Rate / Q000639:trends