Цель. Выявить и оценить предикторы инфекционных осложнений в послеоперационном периоде панкреатодуоденальной резекции. Материалы и методы. Проведен анализ 790 статей, в которых освещалась тематика осложнений после панкреатодуоденальной резекции. Результаты. Критериям включения соответствовало 75 статей. Исследования с малыми выборками (менее 20 пациентов) не учитывались. Исходя из многофакторности проблемы предупреждения инфекционных осложнений в послеоперационном периоде, результаты обзора распределены на несколько разделов. Первичная билиарная декомпрессия высокоэффективна при синдроме механической желтухи на дооперационном этапе, но сопряжена с риском инфицирования желчи и осложненного течения в послеоперационном периоде. Данные обстоятельства должны учитываться при определении показаний к проведению предоперационного билиарного дренирования, выбору способа декомпрессии, в случаях с применением стентирования следует уделять внимание и выбору материала. Бактериобилия является независимым предиктором инфекций области хирургического вмешательства после панкреатодуоденальной резекции. Заключение. Изменение подхода к антибиотикопрофилактике на основе антибиотикочувствительности микрофлоры может привести к снижению частоты инфекций области хирургического вмешательства, сокращению длительности госпитализации, количеству осложнений, связанных с длительной антибактериальной терапией, снижению скорости распространения антибиотикорезистентности и уменьшению финансовых затрат учреждения на законченный случай оказания медицинской помощи.
Aim. To reveal and evaluate predictors of infectious complications in the postoperative period after pancreatoduodenectomy. Materials and methods. An analysis was made of 790 articles that dealt with the subject of complications after pancreatoduodenectomy. Results. Seventy five articles met the inclusion criteria. Studies with small samples (less than 20 patients) were not considered. Based on the multifactorial nature of the problem of preventing infectious complications in the postoperative period, the results of the review are divided into several sections. PBD is highly effective in obstructive jaundice syndrome at the preoperative stage, but is associated with the risk of bile infection and complications in the postoperative period. These circumstances should be taken into account when determining the indications for PBD, choosing the method of decompression, in cases where stenting is used, attention should also be paid to the choice of material. Bacteriobilia is an independent predictor of surgical site infections (SSI) after PDR. Conclusion. Changing the approach to antibiotic prophylaxis based on the antibiotic sensitivity of the microflora can lead to a decrease in the incidence of SSI, a reduction in the duration of hospitalization, the number of complications associated with long-term antibiotic therapy, a decrease in the rate of spread of antibiotic resistance and a decrease in the financial costs of the institution for a completed case of medical care.
1. Amini N, Spolverato G, Kim Yu, Pawlik TM. Trends in hospital volume and failure to rescue for pancreatic surgery. J Gastrointest Surg. 2015;19(9):1581-92. DOI:10.1007/s11605-015-2800
2. Glasgow RE, Mulvihill SJ. Hospital volume influences outcome in patients undergoing pancreatic resection for cancer. West J Med. 1996:165(5):294-300.
3. Poruk KE, Lin JA, Cooper MA, et al. A novel, validated risk score to predict surgical site infection after pancreaticoduodenectomy. HPB (Oxford). 2016;18(11):893-9. DOI:10.1016/j.hpb.2016.07.011
4. Morikane K. Epidemiology and risk factors associated with surgical site infection after different types of hepatobiliary and pancreatic surgery. Surg Today. 2017;47(10):1208-14. DOI:10.1007/s00595-017-1503-0
5. Gouma DJ, Coelho JC, Fisher JD, et al. Endotoxemia after relief of biliary obstruction by internal and external drainage in rats. Am J Surg. 1986;151(4):476-9.
6. Gouma DJ, Caelho JC, Schlegel JF, et al. The effect of preoperative internal and external biliary drainage on mortality of jaundiced rats. Arch Surg. 1987;122(6):731-4.
7. Gouma DJ, Roughneen PT, Kumar S, et al. Changes in nutritional status associated with obstructive jaundice and biliary drainage in rats. Am J Clin Nutr. 1986;44(3):362-9.
8. Roughneen PT, Gouma DJ, Kulkarni AD, et al. Impaired specific cell-mediated immunity in experimental biliary obstruction and its reversibility by internal biliary drainage. J Surg Res. 1986;41(2):113-25.
9. Bemelmans MH, Gouma DJ, Greve JW, Buurman WA. Effect of antitumour necrosis factor treatment on circulating tumour necrosis factor levels and mortality after surgery in jaundiced mice. Br J Surg. 1993;80(8):1055-8.
10. Scheufele F, Schorn S, Demir IE, et al. Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: A metaanalysis of current literature. Surgery. 2017;161(4):939-50. DOI:10.1016/j.surg.2016.11.001
11. Wu CH, Ho TW, Wu JM, et al. Preoperative biliary drainage associated with biliary stricture after pancreaticoduodenectomy: a population-based study. J Hepatobiliary Pancreat Sci. 2018;25(6):308-18. DOI:10.1002/jhbp.559
12. De Pastena M, Marchegiani G, Paiella S, et al. Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: An analysis of 1500 consecutive cases. Dig Endosc. 2018;30(6):777-84.
13. Crippa S, Cirocchi R, Partelli S, et al. Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors. Eur J Surg Oncol (EJSO). 2016;42(9):1278-85. DOI:10.1016/j.ejso.2016.05.001
14. Müssle B, Hempel S, Kahlert C, et al. Prognostic Impact of Bacterobilia on Morbidity and Postoperative Management After Pancreatoduodenectomy: A Systematic Review and Meta-analysis. World J Surg. 2018;42(9):2951-62. DOI:10.1007/s00268-018-4546-5
15. Ohgi K, Sugiura T, Yamamoto Y, et al. Bacterobilia may trigger the development and severity of pancreatic fistula after pancreatoduodenectomy. Surgery. 2016;160(3):725-30. DOI:10.1016/j.surg.2016.03.032
16. Degrandi O, Buscail E, Martellotto S, et al. Perioperative antibiotherapy should replace prophylactic antibiotics in patients undergoing pancreaticoduodenectomy preceded by preoperative biliary drainage. J Surg Oncol. 2019;120(4):639-45. DOI:10.1002/jso.25622
17. Hentzen JEKR, Smit MA, Bruins MJ, et al. Efficacy of Pre-Operative Antimicrobial Prophylaxis in Patients Undergoing Pancreatoduodenectomy: A Multi-Center Retrospective Analysis. Surg Infect (Larchmt). 2018;19(6):608-13. DOI:10.1089/sur.2018.068
18. Sugimachi K, Iguchi T, Mano Y, et al. Significance of bile culture surveillance for postoperative management of pancreatoduodenectomy. World J Surg Oncol. 2019;17(1):232. DOI:10.1186/s12957-019-1773-7
19. Windisch O, Frossard JL, Schiffer E, et al. Microbiologic Changes Induced by Biliary Drainage Require Adapted Antibiotic Prophylaxis during Duodenopancreatectomy. Surg Infect (Larchmt). 2019;20(8):677-82. DOI:10.1089/sur.2019.088
20. Cengiz TB, Jarrar A, Power C, et al. Antimicrobial Stewardship Reduces Surgical Site Infection Rate, as well as Number and Severity of Pancreatic Fistulae after Pancreatoduodenectomy. Surg Infect (Larchmt). 2020;21(3):212-7. DOI:10.1089/sur.2019.108
21. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8-13. DOI:10.1016/j.surg.2005.05.001
22. Lenz P, Conrad B, Kucharzik T, et al. Prevalence, associations, and trends of biliary-tract candidiasis: a prospective observational study. Gastrointestinal Endoscopy. 2009;70(3):480-7. DOI:10.1016/j.gie.2009.01.038
23. De Pastena M, Paiella S, Azzini AM, et al. Preoperative surveillance rectal swab is associated with an increased risk of infectious complications in pancreaticoduodenectomy and directs antimicrobial prophylaxis: an antibiotic stewardship strategy? HPB (Oxford). 2018;20(6):555-62. DOI:10.1016/j.hpb.2017.12.002
24. Fathi AH, Jackson T, Barati M, et al. Extended Perioperative Antibiotic Coverage in Conjunction with Intraoperative Bile Cultures Decreases Infectious Complications after Pancreaticoduodenectomy. HPB Surg. 2016;2016:3031749. DOI:10.1155/2016/3031749
25. ASHP therapeutic Guidelines on antimicrobial prophylaxis in surgery. American Society of Health-System Pharmacists. Am J Health-Syst Pharm. 1999;56(18):1839-88.
26. Bratzler DW, Houck PM; Surgical Infection Prevention Guideline Writers Workgroup. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg. 2005;189(4):395-404. DOI:10.1016/j.amjsurg.2005.01.015
27. Haga N, Ishida H, Ishiguro T, et al. A prospective randomized study to assess the optimal duration of intravenous antimicrobial prophylaxis in elective gastric cancer surgery. Int Surg. 2012;97(2):169-76. DOI:10.9738/CC91.1
28. Белобородов В.Б., Голощапов О.В., Гусаров В.Г., и др. Методические рекомендации Российской некоммерческой общественной организации «Ассоциация анестезиологов-реаниматологов», Межрегиональной общественной организации «Альянс клинических химиотерапевтов и микробиологов», Межрегиональной ассоциации по клинической микробиологии и антимикробной химиотерапии (МАКМАХ), общественной организации «Российский Сепсис Форум» «Диагностика и антимикробная терапия инфекций, вызванных полирезистентными штаммами микроорганизмов» (обновление 2022 г.). Вестник анестезиологии и реаниматологии. 2020;17(1):52-83 [Beloborodov VB, Goloschapov OV, Gusarov VG, et al. Guidelines of the Association of Anesthesiologists-Intensivists, the Interregional Non-Governmental Organization Alliance of Clinical Chemotherapists and Microbiologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), and NGO Russian Sepsis Forum “Diagnostics and antimicrobial therapy of the infections caused by multiresistant microorganisms“ (update 2022). Messenger of anesthesiology and resuscitation. 2020;17(1):52-83 (in Russian)].
________________________________________________
1. Amini N, Spolverato G, Kim Yu, Pawlik TM. Trends in hospital volume and failure to rescue for pancreatic surgery. J Gastrointest Surg. 2015;19(9):1581-92. DOI:10.1007/s11605-015-2800
2. Glasgow RE, Mulvihill SJ. Hospital volume influences outcome in patients undergoing pancreatic resection for cancer. West J Med. 1996:165(5):294-300.
3. Poruk KE, Lin JA, Cooper MA, et al. A novel, validated risk score to predict surgical site infection after pancreaticoduodenectomy. HPB (Oxford). 2016;18(11):893-9. DOI:10.1016/j.hpb.2016.07.011
4. Morikane K. Epidemiology and risk factors associated with surgical site infection after different types of hepatobiliary and pancreatic surgery. Surg Today. 2017;47(10):1208-14. DOI:10.1007/s00595-017-1503-0
5. Gouma DJ, Coelho JC, Fisher JD, et al. Endotoxemia after relief of biliary obstruction by internal and external drainage in rats. Am J Surg. 1986;151(4):476-9.
6. Gouma DJ, Caelho JC, Schlegel JF, et al. The effect of preoperative internal and external biliary drainage on mortality of jaundiced rats. Arch Surg. 1987;122(6):731-4.
7. Gouma DJ, Roughneen PT, Kumar S, et al. Changes in nutritional status associated with obstructive jaundice and biliary drainage in rats. Am J Clin Nutr. 1986;44(3):362-9.
8. Roughneen PT, Gouma DJ, Kulkarni AD, et al. Impaired specific cell-mediated immunity in experimental biliary obstruction and its reversibility by internal biliary drainage. J Surg Res. 1986;41(2):113-25.
9. Bemelmans MH, Gouma DJ, Greve JW, Buurman WA. Effect of antitumour necrosis factor treatment on circulating tumour necrosis factor levels and mortality after surgery in jaundiced mice. Br J Surg. 1993;80(8):1055-8.
10. Scheufele F, Schorn S, Demir IE, et al. Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: A metaanalysis of current literature. Surgery. 2017;161(4):939-50. DOI:10.1016/j.surg.2016.11.001
11. Wu CH, Ho TW, Wu JM, et al. Preoperative biliary drainage associated with biliary stricture after pancreaticoduodenectomy: a population-based study. J Hepatobiliary Pancreat Sci. 2018;25(6):308-18. DOI:10.1002/jhbp.559
12. De Pastena M, Marchegiani G, Paiella S, et al. Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: An analysis of 1500 consecutive cases. Dig Endosc. 2018;30(6):777-84.
13. Crippa S, Cirocchi R, Partelli S, et al. Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors. Eur J Surg Oncol (EJSO). 2016;42(9):1278-85. DOI:10.1016/j.ejso.2016.05.001
14. Müssle B, Hempel S, Kahlert C, et al. Prognostic Impact of Bacterobilia on Morbidity and Postoperative Management After Pancreatoduodenectomy: A Systematic Review and Meta-analysis. World J Surg. 2018;42(9):2951-62. DOI:10.1007/s00268-018-4546-5
15. Ohgi K, Sugiura T, Yamamoto Y, et al. Bacterobilia may trigger the development and severity of pancreatic fistula after pancreatoduodenectomy. Surgery. 2016;160(3):725-30. DOI:10.1016/j.surg.2016.03.032
16. Degrandi O, Buscail E, Martellotto S, et al. Perioperative antibiotherapy should replace prophylactic antibiotics in patients undergoing pancreaticoduodenectomy preceded by preoperative biliary drainage. J Surg Oncol. 2019;120(4):639-45. DOI:10.1002/jso.25622
17. Hentzen JEKR, Smit MA, Bruins MJ, et al. Efficacy of Pre-Operative Antimicrobial Prophylaxis in Patients Undergoing Pancreatoduodenectomy: A Multi-Center Retrospective Analysis. Surg Infect (Larchmt). 2018;19(6):608-13. DOI:10.1089/sur.2018.068
18. Sugimachi K, Iguchi T, Mano Y, et al. Significance of bile culture surveillance for postoperative management of pancreatoduodenectomy. World J Surg Oncol. 2019;17(1):232. DOI:10.1186/s12957-019-1773-7
19. Windisch O, Frossard JL, Schiffer E, et al. Microbiologic Changes Induced by Biliary Drainage Require Adapted Antibiotic Prophylaxis during Duodenopancreatectomy. Surg Infect (Larchmt). 2019;20(8):677-82. DOI:10.1089/sur.2019.088
20. Cengiz TB, Jarrar A, Power C, et al. Antimicrobial Stewardship Reduces Surgical Site Infection Rate, as well as Number and Severity of Pancreatic Fistulae after Pancreatoduodenectomy. Surg Infect (Larchmt). 2020;21(3):212-7. DOI:10.1089/sur.2019.108
21. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8-13. DOI:10.1016/j.surg.2005.05.001
22. Lenz P, Conrad B, Kucharzik T, et al. Prevalence, associations, and trends of biliary-tract candidiasis: a prospective observational study. Gastrointestinal Endoscopy. 2009;70(3):480-7. DOI:10.1016/j.gie.2009.01.038
23. De Pastena M, Paiella S, Azzini AM, et al. Preoperative surveillance rectal swab is associated with an increased risk of infectious complications in pancreaticoduodenectomy and directs antimicrobial prophylaxis: an antibiotic stewardship strategy? HPB (Oxford). 2018;20(6):555-62. DOI:10.1016/j.hpb.2017.12.002
24. Fathi AH, Jackson T, Barati M, et al. Extended Perioperative Antibiotic Coverage in Conjunction with Intraoperative Bile Cultures Decreases Infectious Complications after Pancreaticoduodenectomy. HPB Surg. 2016;2016:3031749. DOI:10.1155/2016/3031749
25. ASHP therapeutic Guidelines on antimicrobial prophylaxis in surgery. American Society of Health-System Pharmacists. Am J Health-Syst Pharm. 1999;56(18):1839-88.
26. Bratzler DW, Houck PM; Surgical Infection Prevention Guideline Writers Workgroup. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg. 2005;189(4):395-404. DOI:10.1016/j.amjsurg.2005.01.015
27. Haga N, Ishida H, Ishiguro T, et al. A prospective randomized study to assess the optimal duration of intravenous antimicrobial prophylaxis in elective gastric cancer surgery. Int Surg. 2012;97(2):169-76. DOI:10.9738/CC91.1
28. Beloborodov VB, Goloschapov OV, Gusarov VG, et al. Guidelines of the Association of Anesthesiologists-Intensivists, the Interregional Non-Governmental Organization Alliance of Clinical Chemotherapists and Microbiologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), and NGO Russian Sepsis Forum “Diagnostics and antimicrobial therapy of the infections caused by multiresistant microorganisms“ (update 2022). Messenger of anesthesiology and resuscitation. 2020;17(1):52-83 (in Russian).
Авторы
О.Ю. Гасиева1, И.Е. Хатьков1,2, А.Л. Верткин*2
1 ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
* kafedrakf@mail.ru
________________________________________________
Olga Yu. Gasieva1, Igor E. Khatkov1,2, Arkadiy L. Vertkin*2
1 Loginov Moscow Clinical Scientific Center, Moscow, Russia;
2 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
* kafedrakf@mail.ru