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Selective Decontamination of the Digestive Tract in Pancreatic Head Resections—A Propensity Score-Matched Analysis
(1) Background: The postoperative morbidity rate after pancreatic head resection remains high, partly due to infectious complications. The primary aim of this study was to analyze the influence of selective decontamination of the digestive tract (SDD) on the postoperative infection rate after pancre...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9820838/ https://www.ncbi.nlm.nih.gov/pubmed/36615050 http://dx.doi.org/10.3390/jcm12010250 |
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author | Radulova-Mauersberger, Olga Oehme, Florian Doerell, Alexandra Frohneberg, Laura Hempel, Sebastian Weitz, Jürgen Welsch, Thilo Distler, Marius Teske, Christian |
author_facet | Radulova-Mauersberger, Olga Oehme, Florian Doerell, Alexandra Frohneberg, Laura Hempel, Sebastian Weitz, Jürgen Welsch, Thilo Distler, Marius Teske, Christian |
author_sort | Radulova-Mauersberger, Olga |
collection | PubMed |
description | (1) Background: The postoperative morbidity rate after pancreatic head resection remains high, partly due to infectious complications. The primary aim of this study was to analyze the influence of selective decontamination of the digestive tract (SDD) on the postoperative infection rate after pancreatic surgery. (2) Methods: From January 2019, the standard of care for patients undergoing pancreatic head resections at the Department for Visceral, Thoracic, and Vascular Surgery, University Hospital Dresden was the preoperative oral administration of SDD. The influence of SDD was evaluated for patients operated on between January 2019 and June 2020 in comparison to a propensity score-matched cohort, extracted from an existing database including all pancreatic resections from 2012 to 2018. The primary endpoint of the study was the shift of the bacterial load on the intraoperative bile swab test. The secondary endpoint was the association of SDD with postoperative complications. (3) Results: In total, 200 patients either with SDD (n = 100; 50%) or without SDD (non-SDD, n = 100; 50%) were analyzed. In the patient group without a preoperative biliary stent, 44% (n = 11) of the non-SDD group displayed positive bacterial results, whereas that was the case for only 21.7% (n = 10) in the SDD group (p = 0.05). Particularly, Enterobacter species (spp.) were reduced from 41.2% (n = 14) (non-SDD group) to 23.5% (n = 12) (SDD group) (p = 0.08), and Citrobacter spp. were reduced by 13.7% (p = 0.09) from the non-SDD to the SDD cohort. In patients with a preoperative biliary stent, the Gram-negative Enterobacter spp. were significantly reduced from 52.2% (n = 12) in the non-SDD group to 26.8% (n = 11) in the SDD group (p = 0.04). Similarly, Citrobacter spp. decreased by 20.6% from 30.4% (n = 7) to 9.8% (n = 4) in the non-SDD compared to the SDD group (p = 0.04). In general, deep fluid collection and abscesses occurred more frequently in the non-SDD group (36%; n = 36 vs. 27%; n = 27; p = 0.17). (4) Conclusions: Adoption of SDD before pancreatic head surgery may reduce the bacterial load in bile fluid. SDD administration does not significantly affect the postoperative infectious complication rate after pancreatic head resections. |
format | Online Article Text |
id | pubmed-9820838 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-98208382023-01-07 Selective Decontamination of the Digestive Tract in Pancreatic Head Resections—A Propensity Score-Matched Analysis Radulova-Mauersberger, Olga Oehme, Florian Doerell, Alexandra Frohneberg, Laura Hempel, Sebastian Weitz, Jürgen Welsch, Thilo Distler, Marius Teske, Christian J Clin Med Article (1) Background: The postoperative morbidity rate after pancreatic head resection remains high, partly due to infectious complications. The primary aim of this study was to analyze the influence of selective decontamination of the digestive tract (SDD) on the postoperative infection rate after pancreatic surgery. (2) Methods: From January 2019, the standard of care for patients undergoing pancreatic head resections at the Department for Visceral, Thoracic, and Vascular Surgery, University Hospital Dresden was the preoperative oral administration of SDD. The influence of SDD was evaluated for patients operated on between January 2019 and June 2020 in comparison to a propensity score-matched cohort, extracted from an existing database including all pancreatic resections from 2012 to 2018. The primary endpoint of the study was the shift of the bacterial load on the intraoperative bile swab test. The secondary endpoint was the association of SDD with postoperative complications. (3) Results: In total, 200 patients either with SDD (n = 100; 50%) or without SDD (non-SDD, n = 100; 50%) were analyzed. In the patient group without a preoperative biliary stent, 44% (n = 11) of the non-SDD group displayed positive bacterial results, whereas that was the case for only 21.7% (n = 10) in the SDD group (p = 0.05). Particularly, Enterobacter species (spp.) were reduced from 41.2% (n = 14) (non-SDD group) to 23.5% (n = 12) (SDD group) (p = 0.08), and Citrobacter spp. were reduced by 13.7% (p = 0.09) from the non-SDD to the SDD cohort. In patients with a preoperative biliary stent, the Gram-negative Enterobacter spp. were significantly reduced from 52.2% (n = 12) in the non-SDD group to 26.8% (n = 11) in the SDD group (p = 0.04). Similarly, Citrobacter spp. decreased by 20.6% from 30.4% (n = 7) to 9.8% (n = 4) in the non-SDD compared to the SDD group (p = 0.04). In general, deep fluid collection and abscesses occurred more frequently in the non-SDD group (36%; n = 36 vs. 27%; n = 27; p = 0.17). (4) Conclusions: Adoption of SDD before pancreatic head surgery may reduce the bacterial load in bile fluid. SDD administration does not significantly affect the postoperative infectious complication rate after pancreatic head resections. MDPI 2022-12-29 /pmc/articles/PMC9820838/ /pubmed/36615050 http://dx.doi.org/10.3390/jcm12010250 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Radulova-Mauersberger, Olga Oehme, Florian Doerell, Alexandra Frohneberg, Laura Hempel, Sebastian Weitz, Jürgen Welsch, Thilo Distler, Marius Teske, Christian Selective Decontamination of the Digestive Tract in Pancreatic Head Resections—A Propensity Score-Matched Analysis |
title | Selective Decontamination of the Digestive Tract in Pancreatic Head Resections—A Propensity Score-Matched Analysis |
title_full | Selective Decontamination of the Digestive Tract in Pancreatic Head Resections—A Propensity Score-Matched Analysis |
title_fullStr | Selective Decontamination of the Digestive Tract in Pancreatic Head Resections—A Propensity Score-Matched Analysis |
title_full_unstemmed | Selective Decontamination of the Digestive Tract in Pancreatic Head Resections—A Propensity Score-Matched Analysis |
title_short | Selective Decontamination of the Digestive Tract in Pancreatic Head Resections—A Propensity Score-Matched Analysis |
title_sort | selective decontamination of the digestive tract in pancreatic head resections—a propensity score-matched analysis |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9820838/ https://www.ncbi.nlm.nih.gov/pubmed/36615050 http://dx.doi.org/10.3390/jcm12010250 |
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