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Randomized controlled trial of perioperative antimicrobial therapy based on the results of preoperative bile cultures in patients undergoing biliary reconstruction
Author(s) -
Okamura Kunishige,
Tanaka Kimitaka,
Miura Takumi,
Nakanishi Yoshitsugu,
Noji Takehiro,
Nakamura Toru,
Tsuchikawa Takahiro,
Okamura Keisuke,
Shichinohe Toshiaki,
Hirano Satoshi
Publication year - 2017
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.453
Subject(s) - medicine , perioperative , randomized controlled trial , clinical endpoint , surgery , biliary tract surgical procedures , antibiotics , bile duct , common bile duct , pancreaticoduodenectomy , biliary tract , pancreas , microbiology and biotechnology , biology
Background The high frequency of surgical site infections ( SSI s) after hepato‐pancreato‐biliary ( HPB ) surgery is a problem that needs to be addressed. This prospective, randomized, controlled study examined whether perioperative prophylactic use of antibiotics based on preoperative bile culture results in HPB surgery could decrease SSI . Methods Participants comprised 126 patients who underwent HPB (bile duct, gallbladder, ampullary, or pancreatic) cancer surgery with biliary reconstruction at Hokkaido University Hospital between August 2008 and March 2013 ( UMIN Clinical Trial Registry #00001278). Before surgery, subjects were randomly allocated to a targeted group administered antibiotics based on bile culture results or a standard group administered cefmetazole. The primary endpoint was SSI rates within 30 days after surgery. Secondary endpoint was SSI rates for each operative procedure. Results Of the 126 patients, 124 were randomly allocated (targeted group, n = 62; standard group, n = 62). Frequency of SSI after surgery was significantly lower in the targeted group (27 patients, 43.5%) than in the standard group (44 patients, 71.0%; P = 0.002). Among patients who underwent pancreaticoduodenectomy and hepatectomy, SSI occurred significantly less frequently in the targeted group ( P = 0.001 and P = 0.025, respectively). Conclusions This study demonstrated that preoperative bile culture‐targeted administration of prophylactic antibiotics decreased SSI s following HBP surgery with biliary reconstruction.