A clinical study of antibiotic prophylaxis in hepato-biliary surgery for malignant biliary tracttumor

Abstract

Biliary tract infection often develops after hepato-biliary surgery for malignant biliary tract tumor. We evaluated 70 cases to decide the appropriate antibiotic prophylaxis. We investigated the drug sensitivity tests and bacteriologic culture of bile from a drainage tube before and after surgery. The positive rates for bacteria after surgery increased gradually and became 100% 8 days after. The incidence of the postsurgical infection was 53% (37/70): 7 cases were sepsis due to cholangitis, in 5 of which the same kind of bacteria was detected in both bile and blood; 30 cases were intraperitoneal infection,15 originated from anastomotic insufficiency, and 15 from bile leak. As prophylactic antibiotics, piperacillin (PIPC) was ineffective for Enterococcus species, for which vancomycin (VCM) was effective. So was sulbacturn/cefoperazone (SBT/CPZ) for Stenotrophomonas maltophilia, for which minocycline (MINO) was effective. When the infectious sign is seen on 4 th day after surgery, VCM or MINO should be administered as empiric therapy. Especially prophylactic antibiotics should be exchanged to the therapeutic drugs in a high risk group for hepatic failure.