Does the Microbiology of Bactibilia Drive Postoperative Complications After Pancreatoduodenectomy?

Thomas K. Maatman, Daniel J. Weber, Beenish Qureshi, Eugene P. Ceppa, Attila Nakeeb, C. Max Schmidt, Nicholas J. Zyromski, Michael G. House

Research output: Contribution to journalArticle

Abstract

Background: The influence of bile microflora, particularly with broad antimicrobial resistance patterns, on postoperative outcomes after pancreatoduodenectomy (PD), is poorly understood. The aim of this study was to determine the influence of the microbiology of bactibilia on postoperative outcomes following PD. Methods: Intraoperative bile cultures were obtained in 162 patients undergoing PD between 2015 and 2017. Intraoperative bile cultures were analyzed and correlated with short-term outcomes after PD. Independent groups t test, Pearson’s correlation, or Fisher’s exact tests were performed. Hazard ratios (HR) are reported with 95% confidence intervals (CI). Statistical significance was defined as P value of < 0.05. Results: Intraoperative bile cultures were positive in 89/162 patients (55%). The most common bacteria were Enterococcus spp. (n = 48, 54%), Klebsiella spp. (n = 24, 27%), and Enterobacter spp. (n = 17, 19%). Bactibilia was not associated with increased infectious complications, postoperative pancreatic fistula (POPF), or mortality. Enterococcus and Enterobacter were associated with higher rates of incisional (HR, 6.5; 95% CI, 1.2–34.8; P = 0.03) and organ-space surgical site infection (HR, 4.9; 95% CI, 1.1–22.0; P = 0.03), respectively. No single bacterium was associated with POPF, bile leak, cholangitis, 30- or 90-day mortality. Conclusion: Bactibilia, in general, does not increase the risk of developing a postoperative complication following pancreatoduodenectomy; however, Enterococcus and Enterobacter increase the likelihood of developing incisional and organ-space surgical infections, respectively.

Original languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Pancreaticoduodenectomy
Microbiology
Bile
Enterobacter
Enterococcus
Pancreatic Fistula
Confidence Intervals
Bacteria
Surgical Wound Infection
Cholangitis
Klebsiella
Mortality
Infection

Keywords

  • Enterobacter
  • Enterococcus
  • Pancreaticoduodenectomy
  • Postoperative period
  • Surgical wound infection

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Does the Microbiology of Bactibilia Drive Postoperative Complications After Pancreatoduodenectomy? / Maatman, Thomas K.; Weber, Daniel J.; Qureshi, Beenish; Ceppa, Eugene P.; Nakeeb, Attila; Schmidt, C. Max; Zyromski, Nicholas J.; House, Michael G.

In: Journal of Gastrointestinal Surgery, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: The influence of bile microflora, particularly with broad antimicrobial resistance patterns, on postoperative outcomes after pancreatoduodenectomy (PD), is poorly understood. The aim of this study was to determine the influence of the microbiology of bactibilia on postoperative outcomes following PD. Methods: Intraoperative bile cultures were obtained in 162 patients undergoing PD between 2015 and 2017. Intraoperative bile cultures were analyzed and correlated with short-term outcomes after PD. Independent groups t test, Pearson’s correlation, or Fisher’s exact tests were performed. Hazard ratios (HR) are reported with 95{\%} confidence intervals (CI). Statistical significance was defined as P value of < 0.05. Results: Intraoperative bile cultures were positive in 89/162 patients (55{\%}). The most common bacteria were Enterococcus spp. (n = 48, 54{\%}), Klebsiella spp. (n = 24, 27{\%}), and Enterobacter spp. (n = 17, 19{\%}). Bactibilia was not associated with increased infectious complications, postoperative pancreatic fistula (POPF), or mortality. Enterococcus and Enterobacter were associated with higher rates of incisional (HR, 6.5; 95{\%} CI, 1.2–34.8; P = 0.03) and organ-space surgical site infection (HR, 4.9; 95{\%} CI, 1.1–22.0; P = 0.03), respectively. No single bacterium was associated with POPF, bile leak, cholangitis, 30- or 90-day mortality. Conclusion: Bactibilia, in general, does not increase the risk of developing a postoperative complication following pancreatoduodenectomy; however, Enterococcus and Enterobacter increase the likelihood of developing incisional and organ-space surgical infections, respectively.",
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AU - Weber, Daniel J.

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AU - Ceppa, Eugene P.

AU - Nakeeb, Attila

AU - Schmidt, C. Max

AU - Zyromski, Nicholas J.

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AB - Background: The influence of bile microflora, particularly with broad antimicrobial resistance patterns, on postoperative outcomes after pancreatoduodenectomy (PD), is poorly understood. The aim of this study was to determine the influence of the microbiology of bactibilia on postoperative outcomes following PD. Methods: Intraoperative bile cultures were obtained in 162 patients undergoing PD between 2015 and 2017. Intraoperative bile cultures were analyzed and correlated with short-term outcomes after PD. Independent groups t test, Pearson’s correlation, or Fisher’s exact tests were performed. Hazard ratios (HR) are reported with 95% confidence intervals (CI). Statistical significance was defined as P value of < 0.05. Results: Intraoperative bile cultures were positive in 89/162 patients (55%). The most common bacteria were Enterococcus spp. (n = 48, 54%), Klebsiella spp. (n = 24, 27%), and Enterobacter spp. (n = 17, 19%). Bactibilia was not associated with increased infectious complications, postoperative pancreatic fistula (POPF), or mortality. Enterococcus and Enterobacter were associated with higher rates of incisional (HR, 6.5; 95% CI, 1.2–34.8; P = 0.03) and organ-space surgical site infection (HR, 4.9; 95% CI, 1.1–22.0; P = 0.03), respectively. No single bacterium was associated with POPF, bile leak, cholangitis, 30- or 90-day mortality. Conclusion: Bactibilia, in general, does not increase the risk of developing a postoperative complication following pancreatoduodenectomy; however, Enterococcus and Enterobacter increase the likelihood of developing incisional and organ-space surgical infections, respectively.

KW - Enterobacter

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KW - Postoperative period

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