A influência de intervenções pré-operatórias no sistema biliar e da profilaxia antimicrobiana na pancreaticoduodenectomia cefálica: um estudo retrospetivo

Abstract

Background: To reduce the morbidity of cephalic pancreaticoduodenectomy patients we have to choose the correct antibiotic prophylaxis. Following this logic and knowing that a majority of these patients undergo preoperative biliary system interventions that increase the presence of multiresistant microorganisms in the bile, we find it necessary to study if tailored antibiotic prophylaxis to these patients can reduce the incidence of infectious complications. Methods: This is a retrospective observational study involving 39 patients who underwent pancreaticoduodenectomy in a tertiary hospital - Centro Hospitalar e Universitário do São João (CHUSJ) - during the year 2023. Bile fluid was collected during surgery to assess the presence of microorganisms. The presence of post-surgical complications in patients with previous biliary tract instrumentation who underwent internationally recommended prophylactic antibiotic therapy was assessed in comparison with patients without previous instrumentation. Results: Of the 36 participants in the study, 26 of them (72%) had bile samples taken intraoperatively, and 84.6% (n=22) of these samples were positive for bacteraemia. Of the samples with positive cultures, 14 of the patients had previously undergone endoscopic retrograde cholangiopancreatography (ERCP). The most frequent microorganisms in biliary cultures in patients with previous ERCP were K. pneumoniae and E. faecalis. Previous endoscopic retrograde cholangiopancreatography resulted in an increased risk of positive biliary cultures (p = 0.033) and the detection of multidrug-resistant microorganisms (p = 0.014). Of the post-surgical complications analysed, the incidence of post-surgical pancreatic fistulas (61.1%) was higher than that of acute cholangitis (11.1%). Conclusions: Preoperative biliary system interventions before cephalic pancreaticoduodenectomy should be acknowledged since they can predict the existence of resistant microorganisms in bile and consequently a higher risk of infectious complications.