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Abstract：
To establish the association between bactibilia and postoperative complications when stratified by perioperative antibiotic prophylaxis.
Patients undergoing pancreatoduodenectomy experience high rates of surgical site infection (SSI) and clinically relevant postoperative pancreatic fistula (CR-POPF). Contaminated bile is known to be associated with SSI, but the role of antibiotic prophylaxis in mitigation of infectious risks is ill-defined.
Intraoperative bile cultures (IOBCs) were collected as an adjunct to a randomized phase 3 clinical trial comparing piperacillin-tazobactam with cefoxitin as perioperative prophylaxis in patients undergoing pancreatoduodenectomy. After compilation of IOBC data, associations between culture results, SSI, and CR-POPF were assessed using logistic regression stratified by the presence of a preoperative biliary stent.
Of 778 participants in the clinical trial, IOBC were available for 247 participants. Overall, 68 (27.5%) grew no organisms, 37 (15.0%) grew 1 organism, and 142 (57.5%) were polymicrobial. Organisms resistant to cefoxitin but not piperacillin-tazobactam were present in 95 patients (45.2%). The presence of cefoxitin-resistant organisms, 92.6% of which contained either Enterobacter spp. or Enterococcus spp., was associated with the development of SSI in participants treated with cefoxitin [53.5% vs 25.0%; odds ratio (OR)=3.44, 95% CI: 1.50-7.91; P =0.004] but not those treated with piperacillin-tazobactam (13.5% vs 27.0%; OR=0.42, 95% CI: 0.14-1.29; P =0.128). Similarly, cefoxitin-resistant organisms were associated with CR-POPF in participants treated with cefoxitin (24.1% vs 5.8%; OR=3.45, 95% CI: 1.22-9.74; P =0.017) but not those treated with piperacillin-tazobactam (5.4% vs 4.8%; OR=0.92, 95% CI: 0.30-2.80; P =0.888).
Previously observed reductions in SSI and CR-POPF in patients that received piperacillin-tazobactam antibiotic prophylaxis are potentially mediated by biliary pathogens that are cefoxitin resistant, specifically Enterobacter spp. and Enterococcus spp.
Patients undergoing pancreatoduodenectomy experience high rates of surgical site infection (SSI) and clinically relevant postoperative pancreatic fistula (CR-POPF). Contaminated bile is known to be associated with SSI, but the role of antibiotic prophylaxis in mitigation of infectious risks is ill-defined.
Intraoperative bile cultures (IOBCs) were collected as an adjunct to a randomized phase 3 clinical trial comparing piperacillin-tazobactam with cefoxitin as perioperative prophylaxis in patients undergoing pancreatoduodenectomy. After compilation of IOBC data, associations between culture results, SSI, and CR-POPF were assessed using logistic regression stratified by the presence of a preoperative biliary stent.
Of 778 participants in the clinical trial, IOBC were available for 247 participants. Overall, 68 (27.5%) grew no organisms, 37 (15.0%) grew 1 organism, and 142 (57.5%) were polymicrobial. Organisms resistant to cefoxitin but not piperacillin-tazobactam were present in 95 patients (45.2%). The presence of cefoxitin-resistant organisms, 92.6% of which contained either Enterobacter spp. or Enterococcus spp., was associated with the development of SSI in participants treated with cefoxitin [53.5% vs 25.0%; odds ratio (OR)=3.44, 95% CI: 1.50-7.91; P =0.004] but not those treated with piperacillin-tazobactam (13.5% vs 27.0%; OR=0.42, 95% CI: 0.14-1.29; P =0.128). Similarly, cefoxitin-resistant organisms were associated with CR-POPF in participants treated with cefoxitin (24.1% vs 5.8%; OR=3.45, 95% CI: 1.22-9.74; P =0.017) but not those treated with piperacillin-tazobactam (5.4% vs 4.8%; OR=0.92, 95% CI: 0.30-2.80; P =0.888).
Previously observed reductions in SSI and CR-POPF in patients that received piperacillin-tazobactam antibiotic prophylaxis are potentially mediated by biliary pathogens that are cefoxitin resistant, specifically Enterobacter spp. and Enterococcus spp.
摘要：
目的：确定按围手术期抗生素预防进行分层时，胸痛与术后并发症之间的关系。
背景：接受胰十二指肠切除术（PD）的患者手术部位感染（SSI）和临床相关的术后胰瘘（CR-POPF）的发生率很高。已知胆汁污染与SSI有关，但是抗生素预防在减轻感染风险中的作用尚不明确。
方法：收集术中胆汁培养物（IOBC）作为一项比较哌拉西林-他唑巴坦和头孢西丁作为PD患者围手术期预防的3期随机临床试验的辅助手段。IOBC数据出现并发症后，文化结果之间的关联，SSI,和CR-POPF使用逻辑回归进行评估，根据术前胆道支架的存在进行分层。
结果：在临床试验的778名参与者中，247名参与者可获得IOBC。总的来说,68（27.5％）没有生物生长，37(15.0%)种一种生物，142例（57.5%）为多微生物。95例患者（45.2％）对头孢西丁耐药，对哌拉西林-他唑巴坦耐药。头孢西丁抗性生物的存在，其中92.6%含有肠杆菌或肠球菌，在接受头孢西丁治疗的参与者中,与SSI发生相关(53.5%vs25.0%;OR3.44,95CI1.50-7.91;P=0.004),但在接受哌拉西林-他唑巴坦治疗的参与者中,与SSI发生相关(13.5%vs27.0%;OR0.42,95CI0.14-1.29;P=0.128).同样，在接受头孢西丁治疗的参与者中，头孢西丁耐药菌与CR-POPF相关(24.1%vs5.8%;OR3.45,95CI1.22-9.74;P=0.017)，但与接受哌拉西林-他唑巴坦治疗的参与者无关(5.4%vs4.8%;OR0.92,95CI0.30-2.80;P=0.888)。
结论：先前观察到的在接受哌拉西林-他唑巴坦抗生素预防的患者中SSI和CR-POPF的降低可能是由对头孢西丁耐药的胆道病原体介导的，特别是肠杆菌属和肠球菌属。
背景：接受胰十二指肠切除术（PD）的患者手术部位感染（SSI）和临床相关的术后胰瘘（CR-POPF）的发生率很高。已知胆汁污染与SSI有关，但是抗生素预防在减轻感染风险中的作用尚不明确。
方法：收集术中胆汁培养物（IOBC）作为一项比较哌拉西林-他唑巴坦和头孢西丁作为PD患者围手术期预防的3期随机临床试验的辅助手段。IOBC数据出现并发症后，文化结果之间的关联，SSI,和CR-POPF使用逻辑回归进行评估，根据术前胆道支架的存在进行分层。
结果：在临床试验的778名参与者中，247名参与者可获得IOBC。总的来说,68（27.5％）没有生物生长，37(15.0%)种一种生物，142例（57.5%）为多微生物。95例患者（45.2％）对头孢西丁耐药，对哌拉西林-他唑巴坦耐药。头孢西丁抗性生物的存在，其中92.6%含有肠杆菌或肠球菌，在接受头孢西丁治疗的参与者中,与SSI发生相关(53.5%vs25.0%;OR3.44,95CI1.50-7.91;P=0.004),但在接受哌拉西林-他唑巴坦治疗的参与者中,与SSI发生相关(13.5%vs27.0%;OR0.42,95CI0.14-1.29;P=0.128).同样，在接受头孢西丁治疗的参与者中，头孢西丁耐药菌与CR-POPF相关(24.1%vs5.8%;OR3.45,95CI1.22-9.74;P=0.017)，但与接受哌拉西林-他唑巴坦治疗的参与者无关(5.4%vs4.8%;OR0.92,95CI0.30-2.80;P=0.888)。
结论：先前观察到的在接受哌拉西林-他唑巴坦抗生素预防的患者中SSI和CR-POPF的降低可能是由对头孢西丁耐药的胆道病原体介导的，特别是肠杆菌属和肠球菌属。
