The association between bacterobilia and the risk of postoperative complications following pancreaticoduodenectomy

HPB (Oxford). 2022 Feb;24(2):277-285. doi: 10.1016/j.hpb.2021.06.428. Epub 2021 Jul 6.

Abstract

Background: Pre-operative biliary bacterial colonisation (bacterobilia) is considered a risk factor for infectious complications after pancreaticoduodenectomy (PD). This study aimed to investigate the role of the PD biliary microbiome grown in the development of post-PD complications.

Methods: In a retrospective study of 162 consecutive patients undergoing PD (2008-2018), intra-operative bile cultures were analyzed and sensitivities compared to pre-anesthetic antibiotics and thirty-day post-surgery complications.

Results: Bacterobilia was present in 136 patients (84%). Most bile cultures grew bacteria resistant to pre-operative antibiotics (n = 112, 82%). Patients with bacterobilia had significantly higher rates of major complication than patients without (P = 0.017), as well as higher rates of surgical-site infections (SSI) (P = 0.010). Patients with negative bile cultures (n = 26) had significantly lower rates of major complication and SSI than those growing sensitive (n = 24) or non-sensitive (n = 112) bacteria (major complication P = 0.029 and SSI P = 0.011).

Conclusion: Positive bile cultures were associated with a higher incidence of major complications and SSI. Patients with sterile bile cultures had the lowest risk of post-operative complications and efforts to reduce rates of bacterobilia, such as limitation of biliary instrumentation, should be considered. Sensitivity to antibiotics had no effect upon the rate of post-operative complications, but this may reflect low cohort numbers.

MeSH terms

  • Bile / microbiology
  • Humans
  • Pancreatectomy / adverse effects
  • Pancreaticoduodenectomy* / adverse effects
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Preoperative Care*
  • Retrospective Studies
  • Surgical Wound Infection / diagnosis
  • Surgical Wound Infection / epidemiology