The microbiological impact of pre‐operative biliary drainage on patients undergoing hepato‐biliary‐pancreatic (HPB) surgery

SUMMARY Background The merit of pre‐operative biliary drainage in managing hepatic, biliary or pancreatic patients remains unclear with previous studies demonstrating significant increases in bacterobilia. Aims To establish if pre‐operative biliary drainage was associated with (i) a change in bacter...

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Published in:Alimentary Pharmacology and Therapeutics 2007-05, Vol.25 (10), p.1175-1180
Main Authors: JETHWA, P., BREUNING, E., BHATI, C., BUCKLES, J., MIRZA, D., BRAMHALL, S.
Format: Article
Language:English
Subjects:
Antibiotic Prophylaxis
Bile Duct Diseases - microbiology
Bile Duct Diseases - surgery
Biological and medical sciences
Cholangiopancreatography, Endoscopic Retrograde - methods
Digestive system
Drainage - methods
Enterococcus
Female
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Liver Diseases - microbiology
Liver Diseases - surgery
Male
Medical sciences
Pancreatic Diseases - microbiology
Pancreatic Diseases - surgery
Pharmacology. Drug treatments
Preoperative Care - methods
Stents
Surgical Wound Infection - microbiology
Treatment Outcome
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Summary:SUMMARY Background The merit of pre‐operative biliary drainage in managing hepatic, biliary or pancreatic patients remains unclear with previous studies demonstrating significant increases in bacterobilia. Aims To establish if pre‐operative biliary drainage was associated with (i) a change in bacterial flora, (ii) post‐operative sepsis and (iii) to ascertain if a modification of antibiotic prophylaxis was warranted. Methods Data were collected on 331 patients undergoing hepatic, biliary or pancreatic surgery for malignant obstruction between August 2000 and June 2005. Microbiological data from intra‐operative bile, post‐operative wounds, blood cultures, urine and sputum were analysed. All episodes of pre‐operative endoscopic retrograde cholangiopancreatography (ERCP), stenting and percutaneous drainage were documented. Results One hundred and sixty two patients had ERCP prior to surgery and 154 had surgery only. In comparison to patients who had surgery alone stented patients had significantly increased rates of bacterobilia (40 vs. 85%) and fungobilia (8 vs. 34%, both P 
ISSN:0269-2813
1365-2036
0953-0673
DOI:10.1111/j.1365-2036.2007.03289.x