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Therapeutic effect of trans-drain administration of antibiotics in patients showing intractable pancreatic leak-associated pus drainage after pancreaticoduodenectomy.

Yoon YI, Hwang S, Cho YJ, Ha TY, Song GW, Jung DH - Korean J Hepatobiliary Pancreat Surg (2015)

Bottom Line: At 2-4 days after the first-session of antibiotics administration, pus-like drain discharge turned to be serous with significantly decreased amount.The results of our study demonstrated that trans-drain administration of antibiotics could be an effective therapeutic option for pancreaticojejunostomy leak-associated infection.Further validation of our result is necessary in large patient populations from multiple centers.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Backgrounds/aims: To cope with intractable pus drainage from persistent pancreatic leak after pancreaticoduodenectomy (PD), we have empirically performed local administration of high-concentration antibiotics cocktail solution into abdominal drains. The purpose of this study was to assess its therapeutic effect in patients showing intractable pus drainage after PD.

Methods: The study group was 10 patients who underwent trans-drain administration of high-concentration antibiotics cocktail solution. Another 10 patients were selected through propensity score matching for the control group. Their medical records were retrospectively reviewed with focus on comparison of pancreatic fistula (PF)-associated clinical sequences.

Results: Postoperative PF of grade B and C occurred in 7 and 3 patients in the study group and 9 and 1 patient in the control group, respectively (p=0.58). In the study group, a mean of 1.8 sessions of antibiotics cocktail solution (imipenem 500 mg and vancomycin 500 mg dissolved in 20 ml of normal saline) was administered. Two patients showed procedure-associated febrile episodes that were spontaneously controlled within 48 hours. At 2-4 days after the first-session of antibiotics administration, pus-like drain discharge turned to be serous with significantly decreased amount. The study group showed shortened postoperative hospital stay comparing to the control group (25.2±4.6 vs. 31.8±5.6 days, p=0.011). In both groups, no patient received radiological or surgical intervention due to PF-associated complications.

Conclusions: The results of our study demonstrated that trans-drain administration of antibiotics could be an effective therapeutic option for pancreaticojejunostomy leak-associated infection. Further validation of our result is necessary in large patient populations from multiple centers.

No MeSH data available.


Related in: MedlinePlus

Eventful sequences of trans-drain administration of excessively large amount of high-concentration antibiotics cocktail solution in a 72-year-female patient with ampulla of Vater cancer. High spiking fever occurred a few hours after trans-drain antibiotics administration. Computed tomography (CT) images are operative CT (A), 10-day CT image showing abnormal fluid collection around the pancreaticojejunostomy site (B), 11-day CT image showing mild diffuse local infiltration collection and scattered free air 1 day after trans-drain antibiotics administration (C), and 18-day CT image showing marked resolution of abnormal fluid collection 7 days after trans-drain antibiotics administration (D).
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Figure 2: Eventful sequences of trans-drain administration of excessively large amount of high-concentration antibiotics cocktail solution in a 72-year-female patient with ampulla of Vater cancer. High spiking fever occurred a few hours after trans-drain antibiotics administration. Computed tomography (CT) images are operative CT (A), 10-day CT image showing abnormal fluid collection around the pancreaticojejunostomy site (B), 11-day CT image showing mild diffuse local infiltration collection and scattered free air 1 day after trans-drain antibiotics administration (C), and 18-day CT image showing marked resolution of abnormal fluid collection 7 days after trans-drain antibiotics administration (D).

Mentions: Following the first-session antibiotics administration, eight patients showed no noticeable adverse effect (Fig. 1). However, two patients showed sudden onset of febrile episodes a few hours after the local administration. Follow-up CT scan performed the next day showed no significant change in one patient. However, another patient showed increase in abnormal fluid collection due to a total of 40 ml solution was accidentally injected into the drains (Fig. 2). In these two patients, fever was spontaneously controlled within 48 hours. At 2 to 4 days after the first-session antibiotics administration, pus-like drain discharge turned to be serous with significantly decreased amount. When such response appeared suboptimal, local antibiotics administration was repeated once or twice again. In all 10 patients, abdominal drains were successfully removed within 10 days after the last session of local administration. This led to shortened postoperative hospital stay comparing to the control group (Table 3). In both study group and control group, no patient received radiological or surgical intervention due to PF-associated complications.


Therapeutic effect of trans-drain administration of antibiotics in patients showing intractable pancreatic leak-associated pus drainage after pancreaticoduodenectomy.

Yoon YI, Hwang S, Cho YJ, Ha TY, Song GW, Jung DH - Korean J Hepatobiliary Pancreat Surg (2015)

Eventful sequences of trans-drain administration of excessively large amount of high-concentration antibiotics cocktail solution in a 72-year-female patient with ampulla of Vater cancer. High spiking fever occurred a few hours after trans-drain antibiotics administration. Computed tomography (CT) images are operative CT (A), 10-day CT image showing abnormal fluid collection around the pancreaticojejunostomy site (B), 11-day CT image showing mild diffuse local infiltration collection and scattered free air 1 day after trans-drain antibiotics administration (C), and 18-day CT image showing marked resolution of abnormal fluid collection 7 days after trans-drain antibiotics administration (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494091&req=5

Figure 2: Eventful sequences of trans-drain administration of excessively large amount of high-concentration antibiotics cocktail solution in a 72-year-female patient with ampulla of Vater cancer. High spiking fever occurred a few hours after trans-drain antibiotics administration. Computed tomography (CT) images are operative CT (A), 10-day CT image showing abnormal fluid collection around the pancreaticojejunostomy site (B), 11-day CT image showing mild diffuse local infiltration collection and scattered free air 1 day after trans-drain antibiotics administration (C), and 18-day CT image showing marked resolution of abnormal fluid collection 7 days after trans-drain antibiotics administration (D).
Mentions: Following the first-session antibiotics administration, eight patients showed no noticeable adverse effect (Fig. 1). However, two patients showed sudden onset of febrile episodes a few hours after the local administration. Follow-up CT scan performed the next day showed no significant change in one patient. However, another patient showed increase in abnormal fluid collection due to a total of 40 ml solution was accidentally injected into the drains (Fig. 2). In these two patients, fever was spontaneously controlled within 48 hours. At 2 to 4 days after the first-session antibiotics administration, pus-like drain discharge turned to be serous with significantly decreased amount. When such response appeared suboptimal, local antibiotics administration was repeated once or twice again. In all 10 patients, abdominal drains were successfully removed within 10 days after the last session of local administration. This led to shortened postoperative hospital stay comparing to the control group (Table 3). In both study group and control group, no patient received radiological or surgical intervention due to PF-associated complications.

Bottom Line: At 2-4 days after the first-session of antibiotics administration, pus-like drain discharge turned to be serous with significantly decreased amount.The results of our study demonstrated that trans-drain administration of antibiotics could be an effective therapeutic option for pancreaticojejunostomy leak-associated infection.Further validation of our result is necessary in large patient populations from multiple centers.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Backgrounds/aims: To cope with intractable pus drainage from persistent pancreatic leak after pancreaticoduodenectomy (PD), we have empirically performed local administration of high-concentration antibiotics cocktail solution into abdominal drains. The purpose of this study was to assess its therapeutic effect in patients showing intractable pus drainage after PD.

Methods: The study group was 10 patients who underwent trans-drain administration of high-concentration antibiotics cocktail solution. Another 10 patients were selected through propensity score matching for the control group. Their medical records were retrospectively reviewed with focus on comparison of pancreatic fistula (PF)-associated clinical sequences.

Results: Postoperative PF of grade B and C occurred in 7 and 3 patients in the study group and 9 and 1 patient in the control group, respectively (p=0.58). In the study group, a mean of 1.8 sessions of antibiotics cocktail solution (imipenem 500 mg and vancomycin 500 mg dissolved in 20 ml of normal saline) was administered. Two patients showed procedure-associated febrile episodes that were spontaneously controlled within 48 hours. At 2-4 days after the first-session of antibiotics administration, pus-like drain discharge turned to be serous with significantly decreased amount. The study group showed shortened postoperative hospital stay comparing to the control group (25.2±4.6 vs. 31.8±5.6 days, p=0.011). In both groups, no patient received radiological or surgical intervention due to PF-associated complications.

Conclusions: The results of our study demonstrated that trans-drain administration of antibiotics could be an effective therapeutic option for pancreaticojejunostomy leak-associated infection. Further validation of our result is necessary in large patient populations from multiple centers.

No MeSH data available.


Related in: MedlinePlus