Does Fungal Biliary Contamination after Preoperative Biliary Drainage Increase Postoperative Complications after Pancreaticoduodenectomy? †
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
2.1. Pre-Intraoperative Patient Characteristics
2.1.1. Preoperative Microbiological Samples
2.1.2. Postoperative Microbiological Samples
Blood Cultures
Postoperative Intra-Abdominal Samples
3. Discussion
4. Materials and Methods
4.1. Patients Selection
4.2. Antimicrobial Prophylaxis and Therapies
4.3. Surgical Technique
4.4. Preoperative, Perioperative, and Postoperative Clinical Data
4.5. Study Design and Study Population
4.6. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
References
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Pre- and Intraoperative Characteristics | All Patient n = 206 | BF Group n = 52 | B Group n = 154 | p Value |
---|---|---|---|---|
Age, median (range) | 66 (60–73) | 66 (60–74) | 67 (60–73) | 0.19 |
Sex ratio M:F | 115/91 | 34/18 | 81/73 | 0.29 |
ASA grade > 2, n (%) | 39 (19%) | 10 (19%) | 29 (19%) | 0.96 |
Diabetes, n (%) | 56 (27%) | 16 (31%) | 40 (26%) | 0.61 |
Preoperative biliary stent, n (%) | 206 (100%) | 52 (100%) | 154 (100%) | 1 |
Duration of drainage (days), median (range) | 54 (34–96) | 62 (41–98) | 49 (31–92) | 0.08 |
Acute pancreatitis, n (%) | 20 (10%) | 5 (10%) | 15 (10%) | 1 |
Cholangitis, n (%) | 21 (10%) | 4 (8%) | 17 (7%) | 0.79 |
Stent changes, n (%) | 18 (9%) | 4 (8%) | 14 (11%) | 1 |
Neo-adjuvant therapy, n (%) | 57 (28%) | 16 (31%) | 41 (27%) | 0.67 |
Preoperative serum bilirubin μmol/L, median (range) | 31 (8–35) | 28 (8–35) | 17 (8–37) | 0.57 |
Preoperative Albumin g/L, median (range) | 36 (35–36) | 35 (35–36) | 36 (35–36) | 0.53 |
Procedure duration (min), median (range) | 400 (320–470) | 410 (330–450) | 390 (320–470) | 0.82 |
Venous resection, n (%) | 61 (30%) | 20 (38%) | 41 (27%) | 0.24 |
Other organs resected, n (%) | 12 (6%) | 7 (13%) | 5 (3%) | 0.02 |
Blood loss (mL), median (range) | 300 (200–500) | 250 (200–400) | 300 (200–500) | 0.31 |
RBC transfusion needed, n (%) | 48 (23%) | 11 (21%) | 37 (24%) | 0.74 |
Short-Term Outcomes | All Patient n = 206 | BF Group n = 52 | B Group n = 154 | p Value |
---|---|---|---|---|
Overall complications *, n (%) | 149 (72%) | 41 (79%) | 108 (70%) | 0.63 |
Clavien–Dindo > 2, n (%) | 48 (23%) | 12 (23%) | 36 (23%) | 0.97 |
Pancreatic fistula, n (%) | 58 (28%) | 16 (31%) | 42 (28%) | 0.82 |
Grade B or C, n (%) | 39 (19%) | 13 (25%) | 26 (17%) | 0.29 |
Delayed gastric emptying, n (%) | 43 (21%) | 10 (19%) | 33 (21%) | 0.78 |
Grade B or C, n (%) | 16 (8%) | 4 (8%) | 12 (8%) | 1 |
Hemorrhage, n (%) | 27 (13%) | 5 (10%) | 22 (14%) | 0.63 |
Global infectious complications ** | 90 (44%) | 26 (50%) | 64 (42%) | 0.51 |
Intra-abdominal collection/sepsis, n (%) | 48 (23%) | 14 (27%) | 34 (22%) | 0.58 |
Urinary tract infection, n (%) | 16 (8%) | 8 (15%) | 8 (5%) | 0.04 |
Pneumonia, n (%) | 10 (5%) | 1 (2%) | 9 (6%) | 0.46 |
Central intravenous catheter infections, n (%) | 26 (13%) | 8 (15%) | 18 (12%) | 0.63 |
Sepsis, n (%) | 34 (17%) | 4 (8%) | 30 (19%) | 0.12 |
Parietal abscess, n (%) | 11 (5%) | 2 (4%) | 9 (6%) | 0.73 |
Cholangitis, n (%) | 2 (1%) | 0 (0%) | 2 (1%) | 1 |
Reoperation, n (%) | 8 (5%) | 2 (4%) | 6 (4%) | 1 |
90-day mortality, n (%) | 12 (6%) | 4 (8%) | 8 (5%) | 0.51 |
Analysis of Intraoperative Biliary Samples | BF Group n = 52 | B Group n = 154 | p Value |
---|---|---|---|
Fungal contamination with one species, n (%) | 45 (87%) | - | NA |
Multiple fungal contamination, n (%) | 7 (13%) | - | NA |
Fungal species, n (%) * | |||
Candida albicans | 27 (44%) | - | NA |
Candida glabrata | 10 (16%) | - | NA |
Candida krusei | 6 (10%) | - | NA |
Candida tropicalis | 6 (10%) | - | NA |
Candida kefyr | 3 (5%) | - | NA |
Others | 9 (15%) ** | - | NA |
No. of patients with a positive bacterial sample, n (%) *** | 52 (100%) | 154 (100%) | 0.81 |
Monobacterial | 4 (8%) | 13 (12%) | 1 |
Multi-bacterial | 48 (92%) | 99 (88%) | 0.14 |
Bacterial species, n (%) | |||
Enterococcus spp. | 47 (29%) | 121 (30%) | 0.77 |
Enterobacter spp. | 15 (9%) | 34 (9%) | 0.87 |
Escherichia coli | 25 (16%) | 89 (22%) | 0.14 |
Klebsiella spp. | 21 (13%) | 60 (15%) | 0.60 |
Citrobacter spp. | 10 (6%) | 15 (4%) | 0.27 |
Proteus spp. | 9 (5%) | 15 (4%) | 0.37 |
Streptococcus spp. | 12 (7%) | 21 (5%) | 0.43 |
Hafnia spp. | 8 (5%) | 14 (3%) | 0.48 |
Anaerobic species | 4 (2%) **** | 10 (2%) ***** | 1 |
Others | 14 (8%) ****** | 20 (6%) ******* | 0.17 |
Analysis of Postoperative Blood Cultures | BF Group n = 52 | B Group n = 154 | p Value |
---|---|---|---|
Positive blood cultures, n (%) | 11 (21%) | 24 (16%) | 0.53 |
No. Patients with a positive fungal sample, n (%) * | 1 (9%) | 3 (12%) | 1 |
One species, n (%) | 1 (100%) | 3 (100%) | 1 |
Multiple species, n (%) | 0 (100%) | 0 (100%) | NA |
Fungal species, n (%) ** | |||
Candida albicans | 1 (100%) | 1 (33%) | 1 |
Candida krusei | - | 1 (33%) | NA |
Candida glabrata | - | 1 (33%) | NA |
No. patients with a positive bacterial sample, n (%) * | 11 (100%) | 23 (96%) | 1 |
Monobacterial | 5 (45%) | 15 (65%) | 0.75 |
Multi-bacterial | 6 (55%) | 8 (35%) | 0.52 |
Bacterial species, n (%) *** | |||
Staphylococcus spp. | 9 (45%) | 16 (49%) | 1 |
E. coli | 3 (15%) | 4 (12%) | 1 |
Morganella spp. | 2 (10%) | - | NA |
Corynebacterium spp. | 2 (10%) | 1 (3%) | 0.55 |
Klebsiella spp. | - | 2 (6%) | NA |
Enterobacter spp. | - | 2 (6%) | NA |
Enterococcus spp. | - | 1 (3%) | NA |
Others | 3 (15%) **** | 7 (21%) ***** | 0.73 |
Anaerobic species ****** | 1 (5%) | - | NA |
Analysis of Postoperative Intra-Abdominal Samples | BF Group n = 52 | B Group n = 154 | p Value |
---|---|---|---|
Positive postoperative intra-abdominal sample, n (%) | 10 (19%) | 23 (15%) | 0.53 |
No. Patients with a positive fungal sample, n (%) * | 3 (30%) | 3 (13%) | 0.38 |
One species, n (%) | 1 (33%) | 3 (100%) | 1 |
Multiple species, n (%) | 2 (67%) | 0 (0%) | 0.11 |
Fungal species, n (%) ** | |||
Candida albicans | 3 (60%) | 2 (67%) | 1 |
Candida kefyr | - | 1 (33%) | NA |
Candida tropicalis | 1 (20%) | - | NA |
Candida glabrata | 1 (20%) | - | NA |
No. patients with a positive bacterial sample, n (%) * | 10 (100%) | 23 (100%) | 1 |
Monobacterial | 1 (10%) | 10 (43%) | 0.24 |
Multi-bacterial | 9 (90%) | 13 (57%) | 0.41 |
Bacterial species, n (%) *** | 21 | 37 | |
E. Coli | 3 (14%) | 4 (11%) | 0.70 |
Enterobacter spp. | 2 (10%) | 5 (13%) | 1 |
Enterococcus spp. | 4 (19%) | 9 (25%) | 1 |
Staphylococcus spp. | 4 (19%) | 6 (16%) | 1 |
Klebsiella spp. | - | 5 (13%) | NA |
Pseudomonas spp. | - | 4 (11%) | NA |
Corynebacterium spp. | 2 (10%) | - | NA |
Others | 6 (28%) **** | 4 (11%) ***** | 0.18 |
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Tortajada, P.; Sauvanet, A.; Truant, S.; Regenet, N.; Souche, R.; Benoist, S.; Muscari, F.; Regimbeau, J.M.; Gaujoux, S.; Cunha, A.S.; et al. Does Fungal Biliary Contamination after Preoperative Biliary Drainage Increase Postoperative Complications after Pancreaticoduodenectomy? Cancers 2020, 12, 2814. https://doi.org/10.3390/cancers12102814
Tortajada P, Sauvanet A, Truant S, Regenet N, Souche R, Benoist S, Muscari F, Regimbeau JM, Gaujoux S, Cunha AS, et al. Does Fungal Biliary Contamination after Preoperative Biliary Drainage Increase Postoperative Complications after Pancreaticoduodenectomy? Cancers. 2020; 12(10):2814. https://doi.org/10.3390/cancers12102814
Chicago/Turabian StyleTortajada, Pauline, Alain Sauvanet, Stephanie Truant, Nicolas Regenet, Régis Souche, Stéphane Benoist, Fabrice Muscari, Jean Marc Regimbeau, Sebastien Gaujoux, Antonio Sa Cunha, and et al. 2020. "Does Fungal Biliary Contamination after Preoperative Biliary Drainage Increase Postoperative Complications after Pancreaticoduodenectomy?" Cancers 12, no. 10: 2814. https://doi.org/10.3390/cancers12102814