title: Cholangitis in the postoperative course after biliodigestive anastomosis.
abstract: BACKGROUND
  Hepatobiliary surgery with biliodigestive anastomosis (BDA) results in a loss of the sphincter of Oddi with consecutive ascension of bacteria into the bile system which may cause cholangitis in the postoperative course.
  
  
  METHODS
  Patients who received reconstruction with a BDA after hepatobiliary surgery were analyzed retrospectively for their postoperative course of disease depending on intraoperatively obtained bile cultures and antibiotic prophylaxis.
  
  
  RESULTS
  Two hundred forty-three patients were included in the analysis, 49.4 % of whom had received endoscopic stenting before the operation. Stenting was significantly associated with the presence of drug-resistant bacteria in the intraoperatively obtained bile sample (p < 0.001, OR = 4.09). Of all patients, 14.4 % developed postoperative cholangitis. This was significantly associated with the postoperative length of stay in the intensive care unit (p = 0.002, OR = 1.035). The highest incidence of postoperative cholangitis was found in patients with cholangiocellular carcinoma (n = 12, p = 0.046, OR = 2.178). Patients were more likely to harbor strains with resistance against the antibiotic that was given intraoperatively.
  
  
  CONCLUSIONS
  The risk for the presence of drug-resistant bacteria is increased by preoperative stenting of the common bile duct. Bile culture by intraoperative swabs can be altered by the perioperative antibiotic prophylaxis as it induces microbiological selection in the common bile duct.
authors.affiliation: General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany. cammann.sebastian@mh-hannover.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Cammann
authors.affiliation: General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Timrott
authors.affiliation: Institute for Medical Microbiology and Hospital Epidemiology, Hanover Medical School, Hanover, Germany.
authors.forename: Ralf-Peter
authors.initials: RP
authors.lastname: Vonberg
authors.affiliation: General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
authors.forename: Florian W R
authors.initials: FW
authors.lastname: Vondran
authors.affiliation: Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation, Hanover Medical School, Hanover, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Schrem
authors.affiliation: Institute for Medical Microbiology and Hospital Epidemiology, Hanover Medical School, Hanover, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Suerbaum
authors.affiliation: General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
authors.affiliation: General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Bektas
authors.affiliation: General, Visceral and Transplant Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Kleine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D019072:Antibiotic Prophylaxis; D001646:Bile; D001650:Bile Duct Neoplasms / Q000601:surgery*; D002761:Cholangitis / Q000209:etiology* / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D055815:Young Adult
keywords: Antibiotic treatment; Bile duct cancer; Biliodigestive anastomosis; Pancreatic carcinoma; Postoperative cholangitis