Do positive bile cultures influence morbidity and mortality after duodenopancreatectomy?

Abstract

Background and aims. Bacterobilia is associated with postoperative morbidity after pancreatico-duodenectomy (PD), mostly due to infectious complications. Investigating the frequency of bacterial species isolated from intraoperative biliary cultures and associated problems following PD was the goal of this study.

Methods. The frequency of isolated bacterial species and surgical complications were evaluated using an ANOVA test. The relationship between biliary cultures and each of the following complications: delayed gastric emptying (DGE), post-operative pancreatic fistula (POPF), biliary fistula and surgical site infectious (SSIs) were evaluated by using the odds ratio.

Results. In 340/513 (66%) of the PDs, positive biliary cultures were discovered. In patients with complications following surgery, different polymicrobial biliary cultures were shown to be more prevalent. A noteworthy incidence of biliary cultures confirming the presence of E. Coli, Klebsiella pneumoniae, and Enterococcus fæcalis (p < 0.001) was noted in SSIs (surgical site infectious). There was a strong correlation (p < 0.001) between the prevalences of polymicrobial biliary cultures containing Escherichia coli, Klebsiella pneumoniæ, Enterococcus fæcalis, and Enterococcus fæcium and POPF. Higher incidence of intra-abdominal collection and DGE was observed in biliary cultures positive for Escherichia coli, Enterococcus fæcalis, and Enterococcus fæcium (p < 0.001). Notably, as a distinct complication, Escherichia coli was substantially linked to DGE (p < 0.01).

Conclusion. While monomicrobial Escherichia coli bacterobilia is linked to DGE as a distinct consequence following PD, specific prevalences of polymicrobial bacterobilia are related with severe complications.