Efecto de la colocación de prótesis biliares preoperatorias en las complicaciones infecciosas de la duodenopancreatectomía cefálica / The effect of a preoperative biliary prosthesis on the infectious complications of the pancreaticoduodenectomy

Introducción: existe controversia sobre el efecto de las prótesis biliares preoperatorias (PBP) en las complicaciones de la duodenopancreatectomía (DPC). No hay recomendaciones para la profilaxis antibiótica en estos pacientes. Nuestro objetivo es estudiar la asociación de las PBP, bacteriología y el desarrollo de complicaciones después de la DP. Métodos: estudio observacional retrospectivo con 90 pacientes consecutivos sometidos a DPC entre 2015-2018. Se indicó PBP en pacientes con bilirrubina total > 12 mg/dl que no pudieron ser intervenidos en un tiempo razonable. La profilaxis antibiótica fue cefoxitina en pacientes sin PBP y tratamiento de cinco días con piperacilina-tazobactam con PBP. Se realizó sistemáticamente un cultivo de bilis. Resultados: la edad promedio fue de 69 años. Cincuenta y un pacientes tuvieron complicaciones (56%), con una mortalidad del 3%. La estancia media fue de once días. Se colocó PBP en 51 pacientes (56%). La profilaxis antibiótica fue adecuada en 62 pacientes (69%). Los gérmenes más aislados fueron E. faecium (30%), E. coli (20%) y E. faecalis (19%). Los pacientes con PBP tuvieron un porcentaje significativamente mayor de cultivos positivos (98% frente a 25%, p < 0,01), mayor número de gérmenes (2,9 frente a 0,5, p < 0,01) y sepsis perioperatoria (31% frente a 12%, p = 0,03), sin aumentar la estancia o la morbilidad global. Conclusiones: las PBP aumentan el riesgo de sepsis perioperatoria, el porcentaje de cultivos positivos y el número promedio de gérmenes aislados. El protocolo de profilaxis con cefoxitina y el tratamiento con pipercilina-tazobactan con PBP tratan adecuadamente al 69% de los pacientes. Con este protocolo, las PBP no implican un aumento de las complicaciones ni de la estancia

Introduction: there is controversy about the effect of a preoperative biliary prosthesis (PBP) on complications of pancreaticoduodenectomy (PD). There are no recommendations for antibiotic prophylaxis in these patients. The objective of the study was to analyze the association of PBP, bacteriology and the development of complications after PD. Methods: this was a retrospective observational study with 90 consecutive patients that underwent DP between 2015 and 2018. PBP was indicated in patients with total bilirubin levels > 12 mg/dl who could not be operated on within a reasonable time. Antibiotic prophylaxis with cefoxitin was administered in patients without PBP and a five-day treatment with piperacillin-tazobactam for PBP. A bile culture was systematically performed. Results: the average age of the patient cohort was 69 years. Fifty-one patients suffered complications (56%), with a mortality rate of 3%. The average hospital stay was eleven days and PBP was placed in 51 patients (56%). Antibiotic prophylaxis was adequate in 62 patients (69%). The most frequently isolated bacteria were E. faecium (30%), E. coli (20%) and E. faecalis (19%). Patients with PBP had a significantly higher percentage of positive cultures (98% vs 25%, p < 0.01), a higher number of bacteria (2.9 vs 0.5, p < 0.01) and perioperative sepsis (31% vs 12%, p = 0.03), but without an increased hospital stay or overall morbidity. Conclusions: PBPs increase the risk of perioperative sepsis, the percentage of positive cultures and the average number of isolated bacteria. The protocol of prophylaxis with cefoxitin and the administration of pipercillin-tazobactan with PBP adequately treated 69% of patients. With this protocol, PBPs do not imply an increase in complications or hospital stay

The effect of a preoperative biliary prosthesis on the infectious complications of the pancreaticoduodenectomy.

INTRODUCTION: there is controversy about the effect of a preoperative biliary prosthesis (PBP) on complications of pancreaticoduodenectomy (PD). There are no recommendations for antibiotic prophylaxis in these patients. The objective of the study was to analyze the association of PBP, bacteriology and the development of complications after PD. METHODS: this was a retrospective observational study with 90 consecutive patients that underwent DP between 2015 and 2018. PBP was indicated in patients with total bilirubin levels > 12 mg/dl who could not be operated on within a reasonable time. Antibiotic prophylaxis with cefoxitin was administered in patients without PBP and a five-day treatment with piperacillin-tazobactam for PBP. A bile culture was systematically performed. RESULTS: the average age of the patient cohort was 69 years. Fifty-one patients suffered complications (56%), with a mortality rate of 3%. The average hospital stay was eleven days and PBP was placed in 51 patients (56%). Antibiotic prophylaxis was adequate in 62 patients (69%). The most frequently isolated bacteria were E. faecium (30%), E. coli (20%) and E. faecalis (19%). Patients with PBP had a significantly higher percentage of positive cultures (98% vs 25%, p < 0.01), a higher number of bacteria (2.9 vs 0.5, p < 0.01) and perioperative sepsis (31% vs 12%, p = 0.03), but without an increased hospital stay or overall morbidity. CONCLUSIONS: PBPs increase the risk of perioperative sepsis, the percentage of positive cultures and the average number of isolated bacteria. The protocol of prophylaxis with cefoxitin and the administration of pipercillin-tazobactan with PBP adequately treated 69% of patients. With this protocol, PBPs do not imply an increase in complications or hospital stay.