Pattern of Microbiology Cultures of Biliary Stents in Patients Undergoing Pancreaticoduodenectomy

Abstract

OBJECTIVE: The objective of the study was to see the organisms growth from culture sensitivities of stents retrieved during pancreaticoduodenectomies, and efficacy of routinely used antibiotics.

METHODS:The study was conducted at Shaukat Khanum memorial cancer hospital and research center (SKMCH) from Dec 2014 to May 2018. This is a retrospective case series.Total number of patients included were 81. All patients who underwent pancreaticoduodenectomies and were stented preoperatively were included in the study. The patterns of microbial growth and their sensitivities to various antibiotics were recorded.

RESULTS: From Dec 2014 to May 2018 a total of 122 patients underwent pancreaticoduodenectomy. The 98 patients were stented preoperatively. Stents were retrieved in 81 patients. Cultures were followed for all patients. The 23 patients had growth of ecoli, 6 showed klebsiella while 47(58%) patients had poly-microbial growth patterns. Ecoli was again found to be most prevalent in polymicrobial presentation forms, followed by enterococcus and klebsiella.Antibiotic sensitivities were assessed. 84% of ecoli grown were resistant to cephalosporins (first line recommended antibiotic for Whipple procedure). There was 38% resistance to piperacillin-tazobactum and 15% resistance to carbapenems. Likewise for the poly-microbial group, 90% resistance to cephalosporins, 47% to piperacillin-tazobactum and only 21% resistance to carbapenems.Wound infections were seen in 40 patients which were correlated with stent tips microorganisms.

CONCLUSION :Stents are colonized with poly-microbial infections. Ecoli and enterococcus are the most common organisms. Piperacillin-tazobactum and carbapenems group showed promising results. The standard recommended antibiotics (cephalosporins) showed a very high number of resistance in our population group.