Bacterobilia in pancreatic surgery-conclusions for perioperative antibiotic prophylaxis

Table 1 Surgical treatment data from 285 patients with pancreatic head resection

	All patients, n = 285 (%)	With bacteriobilia (BB+), n = 150 (%)	Without bacteriobilia (BB-), n = 135 (%)	P value
Indications
Malignancy	n = 202 (71)	n = 114 (56)a	n = 88 (44)	< 0.05
cP1	n = 51 (18)	n =23 (45)	n =28 (55)	0.23
Others	n = 32 (11)	n =13 (41)	n =19 (59)	0.15
Biliary drainage
PBD+	n =144 (51)	n = 120 (83)b	n = 24 (17)	< 0.01
PBD-	n =141 (49)	n = 30 (21)b	n = 111 (79)
Cholestasis
PC+	n = 120 (42)	n = 73 (61)c	n = 47 (39)	0.02
PC-	n = 165 (58)	n = 77 (47)c	n = 88 (53)

¹cP = Chronic pancreatitis.

^aP < 0.05 vs BB-;

^bP < 0.01 vs BB-;

^cP = 0.02 vs BB-. PBD: Preoperative biliary drainage; PC: Preoperative cholestasis; BB: Bacterobilia.

Table 2 Pathogen detection depending on horizontal drain (PBD+/PBD-) or presence of cholestasis (PC+/PC-)

Clinical group	Number of patients, (n)	Patients with bacterobilia, n (%)	Bacteria quantity, n	Fungi
PBD-/PC-No stent/no cholestasis	97	17 (18)	24	0
PBD-/PC+No stent/cholestasis	44	13 (30)	22	2
PBD+/PC-Stent/no cholestasis	68	60 (88)	146	4
PBD+/PC+Stent/cholestase	76	60 (80)	150	9
All groups	285	150 (53)	342

PBD: Preoperative biliary drainage; PC: Preoperative cholestasis.

Table 3 Bacterial profile in patients with bacteriobilia, (n = 150)

Patients with…	PBD-, n (%)	PBD+, n (%)	P value
	30 (20)	120 (80)
Polymicrobial mixed flora (n = 104)	12 (40)d	92 (78)	< 0.01
Enterococci (n = 82)	9 (30)e	73 (61)	< 0.05
Streptococci (n = 41)	6 (20)	35 (29)	0.32
Klebsiella (n = 38)	6 (20)	32 (27)	0.45
Escherichia (n = 35)	8 (27)	27 (23)	0.60
Enterobacter (n = 21)	1 (3)	20 (17)	0.06
Multi-drug resistant bacteria (n = 4)	1 (3)	3 (3)	0.80

^dP < 0.01 vs PBD+,

^eP < 0.05 vs PBD+. PBD: Preoperative biliary drainage.

Table 4 Frequency of sensitivity and resistance compared to standard antibiotic prophylaxis with ampicillin-sulbactam in 342 bacteria

		Ampicillin Sulbactam	Imipenem	Piperacillin Tazobactam	Ciprofloxacin	Moxifloxacin	Ceftriaxon	Cefuroxim
PBD+ (n = 296)	Sensitivity	174 (59)	249 (84)e	219 (74)e	129 (44)e	173 (58)	147 (50)f	126 (43)e
	Resistance	81 (27)	31 (11)e	45 (15)e	96 (32)	49 (17)e	62 (21)f	115 (39)e
PBD- (n = 46)	Sensitivity	31 (67)	37 (80)	33 (72)	18 (39) +	27 (59)	23 (50)f	24 (52)
	Resistance	8 (17)	7 (15)	8 (17)	15 (33)	8 (17)	13 (28)	18 (39)f

Absolute numbers and percentages in brackets,

^eP < 0.01,

^fP < 0.05. PBD: Preoperative biliary drainage.

Table 5 Antimicrobial efficacy of ampicillin-sulbactam and piperacillin-tazobactam in direct comparison with 342 bacteria

		Sensitivity (%)		Signifi-cance	Resistance (%)		Significance
		AS	PT	P	AS	PT	P value
TOP5(n = 256)	Enterococci (n = 97)	71	70	NS	27	29	NS
	Streptococci (n = 58)	60g	88	< 0.01	0	0	NS
	Klebsiella (n = 43)	86	98	NS	14h	0	0.03
	Escherichia (n = 36)	81g	100	< 0.01	19i	0	0.02
	Enterobacter (n = 22)	5g	91	< 0.01	95g	0	< 0.01
Varia(n = 86)	Other genera	40g	80	< 0.01	34g	12	< 0.01

^gP < 0.01 vs PT,

^hP = 0.03 vs PT,

ⁱP = 0.02 vs PT. AS: Ampicillin-sulbactam; PT: Piperacillin-tazobactam; NS: No significance.