Peripancreatic Bacterial Contamination Can Lead to the Development of Postoperative Pancreatic Fistula after Pancreaticoduodenectomy

Abstract

Introduction: The aim of this study was to analyze the relationship between Peripancreatic bacterial contamination (PPBC) and postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) and to investigate the bacterial species in the peripancreatic fluid and identify useful antibiotics to prevent POPF. Methods: Three hundred twenty consecutive patients underwent PD between May 2012 and December 2019. Amylase (D-AMY) and microbial culture have been routinely obtained from the peripancreatic drain on postoperative day (POD) 1, 3, and 6 since May 2012 and Modified Blumgart pancreaticojejunostomy (MBPJ) (N=158) has been adopted since May 2016. POPF was defined as grade B/C according to the international definition. Results: POPF occurred in 26 (16.5%) of 158 patients with MBPJ. In univariate analysis, non-pancreatic disease (P=0.026), body mass index (BMI) >25 kg/m2 (P=0.016), soft pancreas (P=0.009), D-AMY on POD1 >5000 U/L (P< 0.001), and PPBC on POD1 or 3 (P< 0.001) were significantly associated with POPF. In multivariate analysis, BMI >25kg/m2 (Odds ratio [OR]=3.61; P=0.022), D-AMY on POD1 >5000 U/L (OR=5.28; P=0.004) and PPBC on POD1 or 3 (OR=4.96; P=0.003) were independent risk factors of POPF. Of all 320 patients, PPBC gradually increased from POD1 to 6. The most commonly isolated bacteria on POD1 or 3 were Enterococcus sp. (10.9%), Pseudomonas sp. (2.5%), and Enterobacter sp. (1.9%) which were sensitive to piperacillin, imipenem, meropenem, and levofloxacin. Conclusions: Early PPBC after PD can cause the development of POPF. The patients suspected of PPBC should receive more sensitive antibiotics in the early postoperative period to prevent severe POPF.