Su1451 THE MICROBIOME OF TRANSLUMENALLY DRAINED POST-OPERATIVE ABDOMINAL FLUID COLLECTIONS

Abstract

Postoperative fluid collections (POFCs) are a common complication following high-risk pancreatic surgery, occurring in up to 40% of cases. Of these, up to 40% will require additional treatment, for which translumenal drainage (TLD) has been increasingly utilized due to favorable efficacy and safety. Limited data, however, exists on the frequency and associated microbiome of culture-positive (CP) POFC that have undergone TLD which could be helpful in guiding initial therapy. To describe the microbiology and antimicrobial management of patients found to have CP POFC after index TLD. Patients who underwent abdominal surgery and subsequent endoscopic ultrasound for TLD from 2013-2018 were included. Cultures were collected at the index TLD procedure. Electronic medical records were reviewed to collect data on surgery, TLD procedure(s), and associated microbiology. Of 75 patients who underwent TLD, 36 (48%; 50% male, mean age 58.1±13.7 y) had CP POFC. CP POFC was associated with the following surgeries: 29 (80.6%) distal pancreatectomy, 3 (8.3%) Whipple, and 4 (11.1%) other such as pancreatic enucleation and sarcoma resection; and the following pathology: 12 (33.3%) adenocarcinoma, 9 (25%) neuroendocrine tumor, 5 (13.9%) intraductal papillary mucosal neoplasm, 3 (8.3%) mucinous cystic neoplasm, 2 (5.6%) serous cystadenoma, and 5 (13.9%) other including cholangiocarcinoma, colon adenocarcinoma, renal cell carcinoma, and sarcoma. Mean CP POFC size was 8.1±3.0 cm, with 21 (58.3%) demonstrating necrosis. CP POFC were drained on average 44.0±41.3 d from surgery, with a mean total intervention number of 2.2±0.8. Overall, 18 (50%) patients had positive bacterial cultures (BC) and 13 (36.1%) patients had positive fungal cultures (FC). Specifically, 3 patients had negative BC, but positive FC with a single Candida species, while 9 had negative FC, but positive BC. 12 patients did not have specimens collected, but had purulent aspirate, while 3 had negative BC and FC but purulent aspirate. Majority (11; 61.1%) were positive for polymicrobial BC, while 6 (33.3%) were monobacterial with positive FC. Refer to Table 1 for microorganism prevalence. 32 (88.9%) patients were started on antimicrobials. Refer to Table 2 for antimicrobial management. Amoxicillin-clavulanate was most commonly prescribed (14; 38.9%), followed by fluoroquinolones (5; 13.9%) or fluoroquinolones with metronidazole (6; 16.7%). Mean treatment duration was 14.1±15.0 d. Following TLD +/- antimicrobials, 3 (8.3%) redeveloped POFC over mean follow-up duration of 365.1±418.7 d. CP polymicrobial POFC is common among patients who develop symptoms requiring TLD. We found that fungal species occur in a substantial minority of cases, which may change initial treatment strategy for CP POFC while awaiting culture speciation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)