Correlating intraoperative bile culture with postoperative morbidity in pancreaticoduodenectomy

Abstract

Background: The reported incidence of bacteria in bile is extremely variable from 8% to 42%. Several authors have been able to correlate the bacteria cultured from bile at pancreatico-duodenectomy (PD) with those subsequently causing wound infections and septicemia in the postoperative period. In addition, preoperative biliary intervention increases the risk of bactibilia that can translate into increased postoperative morbidity. Materials and Methods: This study was a prospective study conducted at the Department of Surgical Gastroenterology in Sher-I-Kashmir Institute of Medical Sciences from January 2015 to July 2020. A total of 71 patients who underwent PD were included in the study. Results: All patients had intraoperative bile culture (IBC). IBC was positive in forty (56.3%) patients. IBC was more likely to be positive in patients with preoperative intervention as compared to those with no intervention (86.11% vs. 13.89%). IBC was polymicrobial in 28/40 (70%) patients, with Escherichia coli and Klebsiella Pneumoniae both cultured together in 40% of patients. The monomicrobial infection was mainly due to E. coli in 22.5% of patients. Six/40 (15%) patients with bactibilia had wound infection and 4/40 (10%) patients had intra-abdominal collection. Patients with intervention had more of bactibilia (31/36 [86.11%]) compared to that of noninterventional group (9/35 [25.71%]), showing that the intervention was associated with an increased risk of biliary infection. The percentage of multidrug-resistant strains in our study was 97.7%. Conclusion: Positive IBC can determine the cohort of patients who are at risk of postoperative morbidity. Patients with preoperative intervention should be considered potentially infected who deserve careful operative technique to avoid spillage of bile to minimize wound infection and other morbidity. IBC also allows for early appropriate antibiotic use.