Background: Despite improvements in the perioperative care, the morbidity rate after pancreatico-duodenectomy (PD) is still higher than 50%. The aim of this study was twofold: first, to assess the correlation between preoperative rectal swab (RS) and intraoperative bile cultures; to examine the impact of RS isolates on postoperative course after PD. Methods: An observational study was conducted analyzing all consecutive PD performed from January 2015 to July 2016. Based on the positivity/negativity of preoperative RS for multi-drug resistant bacteria, two groups of patients were identified (RS + vs. RS-) and then compared. Results: Three hundred thirty-eight patients were considered for the analysis. RS culture showed a perfect correlation (species and phenotypic antibiotic susceptibility pattern) with bile culture in 157 patients (86.7%). Fifty patients (14.8%) had a RS +. Preoperative biliary drain (PBD) was the single independent preoperative risk factor associated to RS + (p = 0.021, OR = 2.6, 95% CI = 1.5-11.7). Infective complications (IC) and mortality were independently correlated to RS + (p = 0.013, OR = 2.9, 95% CI = 1.3-6.7; p = 0.009 OR = 3.4, 95% CI = 1.8-14.9, respectively). Conclusions: Preoperative surveillance RS-culture's positivity correlates to biliary colonization that occurs after PBD. IC and mortality after PD are associated with RS +. Preoperative RS can direct antibiotic prophylaxis to reduce morbidity and mortality after PD.

Preoperative surveillance rectal swab is associated with an increased risk of infectious complications in pancreaticoduodenectomy and directs antimicrobial prophylaxis: an antibiotic stewardship strategy?

De Pastena, Matteo
;
Paiella, Salvatore;Azzini, Anna M.;Marchegiani, Giovanni;Malleo, Giuseppe;Ciprani, Debora;Mazzariol, Annarita;Secchettin, Erica;BONAMINI, Deborah;Gasparini, Clizia;Concia, Ercole;Bassi, Claudio;Salvia, Roberto
2018-01-01

Abstract

Background: Despite improvements in the perioperative care, the morbidity rate after pancreatico-duodenectomy (PD) is still higher than 50%. The aim of this study was twofold: first, to assess the correlation between preoperative rectal swab (RS) and intraoperative bile cultures; to examine the impact of RS isolates on postoperative course after PD. Methods: An observational study was conducted analyzing all consecutive PD performed from January 2015 to July 2016. Based on the positivity/negativity of preoperative RS for multi-drug resistant bacteria, two groups of patients were identified (RS + vs. RS-) and then compared. Results: Three hundred thirty-eight patients were considered for the analysis. RS culture showed a perfect correlation (species and phenotypic antibiotic susceptibility pattern) with bile culture in 157 patients (86.7%). Fifty patients (14.8%) had a RS +. Preoperative biliary drain (PBD) was the single independent preoperative risk factor associated to RS + (p = 0.021, OR = 2.6, 95% CI = 1.5-11.7). Infective complications (IC) and mortality were independently correlated to RS + (p = 0.013, OR = 2.9, 95% CI = 1.3-6.7; p = 0.009 OR = 3.4, 95% CI = 1.8-14.9, respectively). Conclusions: Preoperative surveillance RS-culture's positivity correlates to biliary colonization that occurs after PBD. IC and mortality after PD are associated with RS +. Preoperative RS can direct antibiotic prophylaxis to reduce morbidity and mortality after PD.
2018
postoperative infections; pancreaticoduodenectomy
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/972103
Citazioni
  • ???jsp.display-item.citation.pmc??? 4
  • Scopus 19
  • ???jsp.display-item.citation.isi??? 19
social impact