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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 |
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| container_title | Alimentary Pharmacology and Therapeutics |
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| creator | JETHWA, P. BREUNING, E. BHATI, C. BUCKLES, J. MIRZA, D. BRAMHALL, S. |
| description | 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 |
| doi_str_mv | 10.1111/j.1365-2036.2007.03289.x |
| format | article |
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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 < 0.001). Pre‐operative biliary drainage significantly increased post‐operative sepsis, wound infections and prolonged in‐patient stay (P < 0.05). The most common organisms cultured were coliforms and enterococcus with percutaneous transhepatic cholangiography (PTC) highly significant for the development of MRSA sepsis.
Conclusions Pre‐operative biliary drainage is associated with a high incidence of bacterobilia and fungal colonization. Pre‐operative biliary drainage should be utilized selectively, with modification of antibiotic prophylaxis according to patient characteristics.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>EISSN: 0953-0673</identifier><identifier>DOI: 10.1111/j.1365-2036.2007.03289.x</identifier><identifier>PMID: 17451563</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>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</subject><ispartof>Alimentary Pharmacology and Therapeutics, 2007-05, Vol.25 (10), p.1175-1180</ispartof><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4479-41e8dd7f7e199e2560eee3dfa86671f12f3b5c5d28e8ecfd11f512331dca825c3</citedby><cites>FETCH-LOGICAL-c4479-41e8dd7f7e199e2560eee3dfa86671f12f3b5c5d28e8ecfd11f512331dca825c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18694589$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17451563$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>JETHWA, P.</creatorcontrib><creatorcontrib>BREUNING, E.</creatorcontrib><creatorcontrib>BHATI, C.</creatorcontrib><creatorcontrib>BUCKLES, J.</creatorcontrib><creatorcontrib>MIRZA, D.</creatorcontrib><creatorcontrib>BRAMHALL, S.</creatorcontrib><title>The microbiological impact of pre‐operative biliary drainage on patients undergoing hepato‐biliary‐pancreatic (HPB) surgery</title><title>Alimentary Pharmacology and Therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>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 < 0.001). Pre‐operative biliary drainage significantly increased post‐operative sepsis, wound infections and prolonged in‐patient stay (P < 0.05). The most common organisms cultured were coliforms and enterococcus with percutaneous transhepatic cholangiography (PTC) highly significant for the development of MRSA sepsis.
Conclusions Pre‐operative biliary drainage is associated with a high incidence of bacterobilia and fungal colonization. Pre‐operative biliary drainage should be utilized selectively, with modification of antibiotic prophylaxis according to patient characteristics.</description><subject>Antibiotic Prophylaxis</subject><subject>Bile Duct Diseases - microbiology</subject><subject>Bile Duct Diseases - surgery</subject><subject>Biological and medical sciences</subject><subject>Cholangiopancreatography, Endoscopic Retrograde - methods</subject><subject>Digestive system</subject><subject>Drainage - methods</subject><subject>Enterococcus</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Liver Diseases - microbiology</subject><subject>Liver Diseases - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Pancreatic Diseases - microbiology</subject><subject>Pancreatic Diseases - surgery</subject><subject>Pharmacology. Drug treatments</subject><subject>Preoperative Care - methods</subject><subject>Stents</subject><subject>Surgical Wound Infection - microbiology</subject><subject>Treatment Outcome</subject><issn>0269-2813</issn><issn>1365-2036</issn><issn>0953-0673</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><recordid>eNqNkM1u1DAURi0EokPhFZA3IFgk-CdxnAWLUgFFqkQXw9ry2NepR0kc7Al0dvAGPCNPgsNEdIs3vvI937V9EMKUlDSvN_uSclEXjHBRMkKaknAm2_LuAdr8azxEG8JEWzBJ-Rl6ktKeECIawh6jM9pUNa0F36Cf21vAgzcx7HzoQ-eN7rEfJm0OODg8Rfj941eYIOqD_wZ453uv4xHbqP2oO8BhxFNuwXhIeB4txC74scO3kE9Djq6BXE16NBEya_Crq5t3r3GaYwfx-BQ9crpP8Gzdz9GXD--3l1fF9eePny4vrgtTVU1bVBSktY1rgLYtsFoQAODWaSlEQx1lju9qU1smQYJxllJXU8Y5tUZLVht-jl6e5k4xfJ0hHdTgk4G-1yOEOSlGGKeUsQzKE5ilpBTBqSn6IX9CUaIW_WqvFstqsawW_eqvfnWXo8_XO-bdAPY-uPrOwIsV0CmbdjFL8emek6Ktatlm7u2J--57OP73A9TFzXap-B_1YaYy</recordid><startdate>200705</startdate><enddate>200705</enddate><creator>JETHWA, P.</creator><creator>BREUNING, E.</creator><creator>BHATI, C.</creator><creator>BUCKLES, J.</creator><creator>MIRZA, D.</creator><creator>BRAMHALL, S.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T7</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>M7N</scope><scope>P64</scope></search><sort><creationdate>200705</creationdate><title>The microbiological impact of pre‐operative biliary drainage on patients undergoing hepato‐biliary‐pancreatic (HPB) surgery</title><author>JETHWA, P. ; BREUNING, E. ; BHATI, C. ; BUCKLES, J. ; MIRZA, D. ; BRAMHALL, S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4479-41e8dd7f7e199e2560eee3dfa86671f12f3b5c5d28e8ecfd11f512331dca825c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Antibiotic Prophylaxis</topic><topic>Bile Duct Diseases - microbiology</topic><topic>Bile Duct Diseases - surgery</topic><topic>Biological and medical sciences</topic><topic>Cholangiopancreatography, Endoscopic Retrograde - methods</topic><topic>Digestive system</topic><topic>Drainage - methods</topic><topic>Enterococcus</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Liver Diseases - microbiology</topic><topic>Liver Diseases - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Pancreatic Diseases - microbiology</topic><topic>Pancreatic Diseases - surgery</topic><topic>Pharmacology. Drug treatments</topic><topic>Preoperative Care - methods</topic><topic>Stents</topic><topic>Surgical Wound Infection - microbiology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>JETHWA, P.</creatorcontrib><creatorcontrib>BREUNING, E.</creatorcontrib><creatorcontrib>BHATI, C.</creatorcontrib><creatorcontrib>BUCKLES, J.</creatorcontrib><creatorcontrib>MIRZA, D.</creatorcontrib><creatorcontrib>BRAMHALL, S.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Alimentary Pharmacology and Therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>JETHWA, P.</au><au>BREUNING, E.</au><au>BHATI, C.</au><au>BUCKLES, J.</au><au>MIRZA, D.</au><au>BRAMHALL, S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The microbiological impact of pre‐operative biliary drainage on patients undergoing hepato‐biliary‐pancreatic (HPB) surgery</atitle><jtitle>Alimentary Pharmacology and Therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2007-05</date><risdate>2007</risdate><volume>25</volume><issue>10</issue><spage>1175</spage><epage>1180</epage><pages>1175-1180</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><eissn>0953-0673</eissn><abstract>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 < 0.001). Pre‐operative biliary drainage significantly increased post‐operative sepsis, wound infections and prolonged in‐patient stay (P < 0.05). The most common organisms cultured were coliforms and enterococcus with percutaneous transhepatic cholangiography (PTC) highly significant for the development of MRSA sepsis.
Conclusions Pre‐operative biliary drainage is associated with a high incidence of bacterobilia and fungal colonization. Pre‐operative biliary drainage should be utilized selectively, with modification of antibiotic prophylaxis according to patient characteristics.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>17451563</pmid><doi>10.1111/j.1365-2036.2007.03289.x</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | The microbiological impact of pre‐operative biliary drainage on patients undergoing hepato‐biliary‐pancreatic (HPB) surgery |
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