Importance: Wound @entity281 after pancreaticoduodenectomy (PD) are common. The standard antibiotic prophylaxis given to prevent the @entity281 is often a @entity8509 . However, this decision is rarely guided by microbiology data pertinent to PD, particularly in @entity1 with biliary stents. Objective: To analyze the microbiology of post-PD wound @entity281 cultures and the effectiveness of institution-based perioperative antibiotic protocols. Design, Setting, and @entity1 : The pancreatic resection databases of 3 institutions (designated as institutions A, B, or C) were queried on @entity1 undergoing PD from June 1, 2008, to June 1, 2013, and a total of 1623 @entity1 were identified. Perioperative variables as well as microbiology data for intraoperative bile and postoperative wound cultures were analyzed from June 1, 2008, to June 1, 2013. Interventions: Perioperative antibiotic administration. Main Outcomes and Measures: Wound @entity281 microbiology analysis and resistance patterns. Results: Of the 1623 @entity1 who underwent PD, 133 with @entity2737 (8.2%) were identified. The wound @entity281 rate did not differ significantly across the 3 institutions. The predominant perioperative antibiotics used at institutions A, B, and C were @entity3398 , @entity7048 with @entity868 , and @entity869 - @entity5899 , respectively. Of the 133 @entity2737 , 89 (67.1%) were deep-tissue @entity281 , occurring at a median of 8 (range, 1-57) days after PD. A total of 53 (40.0%) of the @entity2737 required home visiting nurse services on discharge, and 73 (29.1%) of all PD readmissions were attributed to wound @entity281 . Preoperative biliary stenting was the strongest predictor of @entity6081 (odds ratio, 2.5; 95% CI, 1.58-3.88; P   =   .03). There was marked institutional variation in the type of microorganisms cultured from both the intraoperative bile and wound @entity281 cultures ( @entity328 , 114 cultures [47.9%] in institution A vs 3 [4.5%] in institution B; P   =   .001) and wound @entity281 cultures (predominant microorganism in institution A: @entity797 , 18 cultures [51.4%]; institution B: @entity794 , 8 [43.9%]; and institution C: @entity526 , 17 [36.2%], P   =   .001). Similarly, antibiotic resistance patterns varied (resistance pattern in institution A: @entity3398 , 29 cultures [53.1%]; institution B: @entity869 - @entity5899 , 9 [69.2%]; and institution C: @entity114 , 32 [72.7%], P   <   .001). Microorganisms isolated in intraoperative bile cultures were similar to those identified in wound cultures in @entity1 with @entity2737 . Conclusions and Relevance: The findings of this large-scale, multi-institutional study indicate that intraoperative bile cultures should be routinely obtained in @entity1 who underwent preoperative endoscopic retrograde cholangiopancreatography since the isolated microorganisms closely correlate with those identified on postoperative wound cultures. Institution-specific internal reviews should amend current protocols for antibiotic prophylaxis to reduce the incidence of @entity2737 following PD.

Discordance Between Perioperative Antibiotic Prophylaxis and Wound Infection Cultures in XXXX Undergoing Pancreaticoduodenectomy.

@entity1 :: ('9606', 'Species') :: ['Participants', 'patients'] @entity7048 :: ('MESH:D002437', 'Chemical') :: ['cefazolin sodium'] @entity868 :: ('MESH:D008795', 'Chemical') :: ['metronidazole'] @entity6081 :: ('MESH:D013530', 'Disease') :: ['postoperative wound infection'] @entity114 :: ('MESH:D010406', 'Chemical') :: ['penicillin'] @entity794 :: ('1280', 'Species') :: ['Staphylococcus aureus'] @entity2737 :: ('MESH:D014946', 'Disease') :: ['wound infections', 'post-PD wound infections'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection', 'infections'] @entity797 :: ('1351', 'Species') :: ['Enterococcus faecalis'] @entity8509 :: ('D002511', 'Chemical') :: ['cephalosporin'] @entity869 :: ('MESH:D000667', 'Chemical') :: ['ampicillin sodium', 'ampicillin'] @entity5899 :: ('MESH:D013407', 'Chemical') :: ['sulbactam sodium', 'sulbactam'] @entity328 :: ('1313', 'Species') :: ['Streptococcus pneumoniae'] @entity3398 :: ('MESH:D002440', 'Chemical') :: ['cefoxitin', 'cefoxitin sodium'] @entity526 :: ('562', 'Species') :: ['Escherichia coli']
@entity1 :: (9606,Species) :: ['Patients']
