High incidence of postoperative infections after pancreaticoduodenectomy: A need for perioperative anti-infectious strategies

P. Bortolotti (1, 2) , C. Delpierre (1) , Rémi Le Guern (2, 3) , E. Kipnis (1, 2) , G. Lebuffe (1, 4) , X. Lenne (1) , F.-R. Pruvot (1, 5) , S. Truant (1, 5) , A. Bignon (1) , M. El Amrani (1, 5)

1 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
2 CIIL - Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204
3 Institut de Microbiologie [CHRU Lille]
4 GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées - ULR 7365
5 CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277

ObjectivesPostoperative infections occur frequently after pancreaticoduodenectomy, especially in patients with bile colonization. Recommendations for perioperative anti-infectious treatment are lacking, and clinical practice is heterogenous. We have analyzed the effects of bile colonization and antibiotic prophylaxis on postoperative infection rates, types and therapeutic consequences.MethodsRetrospective observational study in patients undergoing pancreaticoduodenectomy with intraoperative bile culture. Data on postoperative infections and non-infectious complications, bile cultures and antibiotic prophylaxis adequacy to biliary bacteria were collected.ResultsAmong 129 patients, 53% had a positive bile culture and 23% had received appropriate antibiotic prophylaxis. Postoperative documented infection rate was over 40% in patients with or without bile colonization, but antibiotic therapy was more frequent in positive bile culture patients (77% vs. 57%, P = 0,008). The median duration of antibiotic therapy was 11 days and included a broad-spectrum molecule in 42% of cases. Two-thirds of documented postoperative infections involved one or more bacteria isolated in bile cultures, which was associated with a higher complication rate. While bile culture yielded Gram-negative bacilli (57%) and Gram-positive cocci (43%), fungal microorganisms were scarce. Adequate preoperative antibiotic prophylaxis according to bile culture was not associated with reduced infectious or non-infectious complication rates.ConclusionPatients undergoing pancreaticoduodenectomy experience a high rate of postoperative infections, often involving bacteria from perioperative bile culture when positive, with no preventive effect of an adequate preoperative antibiotic prophylaxis. Increased postoperative complications in patients with bile colonization may render necessary a perioperative antibiotic treatment targeting bile microorganisms. Further prospective studies are needed to improve the anti-infectious strategy in these patients.

Mots clés: Perioperative infection; Surgical site infection; Cephalic pancreaticoduodenectomy; Antimicrobial prophylaxis; Bile colonization

Domaines: Maladies infectieuses; Bactériologie

P. Bortolotti, C. Delpierre, Rémi Le Guern, E. Kipnis, G. Lebuffe, et al.. High incidence of postoperative infections after pancreaticoduodenectomy: A need for perioperative anti-infectious strategies. Infectious Diseases Now, 2021, pp.In Press, Corrected Proof. ⟨10.1016/j.idnow.2021.01.001⟩. ⟨hal-03311398⟩