Pancreatic duct fluid culture in patients with chronic pancreatitis undergoing operative intervention and its implications on post operative course

Authors

  • Sai P. Krishna Department of Surgical Gastroenterology, GMKMCH, Salem, Tamil Nadu, India
  • R. D. R. Somasekar Department of Surgical Gastroenterology, GMKMCH, Salem, Tamil Nadu, India
  • Sivasankar A. Department of Surgical Gastroenterology, GMKMCH, Salem, Tamil Nadu, India
  • Kesavan B. Department of Surgical Gastroenterology, GMKMCH, Salem, Tamil Nadu, India
  • Pon M. Chidambaram Department of Surgical Gastroenterology, GMKMCH, Salem, Tamil Nadu, India
  • C. Ramamurthy Department of Surgical Gastroenterology, GMKMCH, Salem, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20214747

Keywords:

Chronic pancreatitis, Pancreatic duct, Culture, Wound infection

Abstract

Background: The role of bacteria in pathogenesis of chronic pancreatitis is poorly understood. Our aim was to analyse pancreatic duct fluid culture in patients undergoing operative intervention for chronic pancreatitis and its implications in post operative outcomes.

Methods: Among 35 patients, 17 underwent Freys, 13 underwent longitudinal pancreatico-jejunostomy, 5 underwent cystojejunostomy. Duct fluid culture was obtained intraoperatively and analysed and compared with preoperative parameters and post operative outcomes.

Results: 20 patients had positive duct fluid culture. Most common pathogen isolated was Klebsiella (8 patients). The only preoperative parameter which showed significant association was fasting blood glucose level. Wound infections were seen in 11 of which 10 had positive duct culture, out of which 9 had the same organism of that in duct culture. Mean hospital stay was 9±1.07 and 10±1.13 days in patients without and with infectious complications respectively.

Conclusions: Older concept of sterile PD fluid in patients with CP may no longer hold true. In our study upto 60% of patients showed positive PD culture. By starting appropriate antibiotic we can reduce the length of hospital stay in patients who have septic complications. However large centre studies may guide us further into the importance of this concept and the role of bacteria in the pathogenesis of CP.

Metrics

Metrics Loading ...

References

Hoffmeister A, Mayerle J, Beglinger C. English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol. 2015;53(12):1447-95.

Kleeff J, Whitcomb DC, Shimosegawa T. Chronic pancreatitis. Nat Rev Dis Primers. 2017;3:17060.

Parida SK, Pottakkat B, Raja K, Vijayahari R, Lakshmi CP. Bacteriological profile of pancreatic juice in patients with chronic pancreatitis. JOP. 2014; 15(5):475-7.

Yelamali A, Mansard M, Rao P, Dama R, Rebela P, Rao GV, Reddy N. Bacteriology of pancreatic fluid in chronic calcific pancreatitis. J Gastroenterol Hepatol. 2011;26 (5): 23.

Brock C, Nielsen LM, Lelic D, Drewes AM. Pathophysiology of chronic pancreatitis. World J Gastroenterol. 2013;19(42):7231-40.

Sah RP, Dawra RK, Saluja AK. New insights into the pathogenesis of pancreatitis. Curr Opin Gastroenterol. 2013;29(5):523-30.

Verdier J, Luedde T, Sellge G. Biliary Mucosal Barrier and Microbiome. Viszeralmedizin. 2015; 31(3):156-61.

Kim KP, Kim MH, Song MH, Lee SS, Seo DW, Lee SK. Autoimmune chronic pancreatitis. Am J Gastroenterol. 2004;99(8):1605-16.

Kountouras J, Zavos C, Chatzopoulos D. A concept on the role of Helicobacter pylori infection in autoimmune pancreatitis. J Cell Mol Med. 2005;9(1): 196-207.

Jesnowski R, Isaksson B, Möhrcke C, Bertsch C, Bulajic M, Schneider-Brachert W et al Helicobacter pylori in autoimmune pancreatitis and pancreatic carcinoma. Pancreatology. 2010;10(4):462-6.

Gregg JA. Detection of bacterial infection of the pancreatic ducts in patients with pancreatitis and pancreatic cancer during endoscopic cannulation of the pancreatic duct. Gastroenterology. 1977;73(5): 1005-7.

Rubén CR, Marco HG, Edelmiro PR, Francisco RS, Gerardo MM. Incidence of bacteria from cultures of bile and gallbladder wall of laparoscopic cholecystectomy patients in the University Hospital. Eleuterio González. 2017;85(6):515-21.

Chandra S, Klair JS, Soota K, Livorsi DJ, Johlin FC. Endoscopic Retrograde Cholangio-Pancreatography-Obtained Bile Culture Can Guide Antibiotic Therapy in Acute Cholangitis. Dig Dis. 2019;37(2):155-60.

Downloads

Published

2021-11-26

Issue

Section

Original Research Articles