Do positive bile cultures influence morbidity and mortality after duodenopancreatectomy?

Background and aims: Bacterobilia is associated with postoperative morbidity after pancreatico-duodenectomy (PD), mostly due to infectious complications. Investigating the frequency of bacterial species isolated from intraoperative biliary cultures and associated problems following PD was the goal of this study.

Methods: The frequency of isolated bacterial species and surgical complications were evaluated using an ANOVA test. The relationship between biliary cultures and each of the following complications: delayed gastric emptying (DGE), post-operative pancreatic fistula (POPF), biliary fistula and surgical site infectious (SSIs) were evaluated by using the odds ratio.

Results: In 340/513 (66%) of the PDs, positive biliary cultures were discovered. In patients with complications following surgery, different polymicrobial biliary cultures were shown to be more prevalent. A noteworthy incidence of biliary cultures confirming the presence of E. Coli, Klebsiella pneumoniae, and Enterococcus fæcalis (p < 0.001) was noted in SSIs (surgical site infectious). There was a strong correlation (p < 0.001) between the prevalences of polymicrobial biliary cultures containing Escherichia coli, Klebsiella pneumoniæ, Enterococcus fæcalis, and Enterococcus fæcium and POPF. Higher incidence of intra-abdominal collection and DGE was observed in biliary cultures positive for Escherichia coli, Enterococcus fæcalis, and Enterococcus fæcium (p < 0.001). Notably, as a distinct complication, Escherichia coli was substantially linked to DGE (p < 0.01).

Conclusion: While monomicrobial Escherichia coli bacterobilia is linked to DGE as a distinct consequence following PD, specific prevalences of polymicrobial bacterobilia are related with severe complications.