Sterility Cultures Following Pancreatectomy with Islet Autotransplantation in the Pediatric Population: Do They Matter?
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ORIGINAL ARTICLE
Sterility Cultures Following Pancreatectomy with Islet Autotransplantation in the Pediatric Population: Do They Matter? Alexander R. Cortez 1,2 & Al-Faraaz Kassam 1,2 & Tom K. Lin 3,4 & Grant C. Paulsen 4,5 & John Brunner 2 & Todd M. Jenkins 1 & Lara A. Danziger-Isakov 4,5 & Syed A. Ahmad 2 & Maisam Abu-El-Haija 3,4 & Jaimie D. Nathan 1,2 Received: 11 June 2019 / Accepted: 11 September 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Background Pancreatectomy with islet autotransplantation (IAT) is a treatment option for children with debilitating chronic pancreatitis. Sterility cultures from preservation solutions are often positive, yet their impact has not been well studied in children. Methods A retrospective review of all patients who underwent IAT from 2015 to 2018 at a single institution was performed. Sterility culture data were obtained from both the pancreas transport and islet transplant media. All patients received prophylactic perioperative meropenem and vancomycin for 72 h per our protocol. If cultures resulted positive, antibiotics were extended for a total of 7 days. Primary outcomes were postoperative fever and 30-day infectious complications. Results Forty-one patients underwent IAT during the study period. Seventeen (41.5 %) patients had negative cultures of both the transport and transplant media, while 24 (58.5 %) patients had a positive culture from either sample. Of these patients, 13 (31.7 %) were positive in both, 10 (24.4 %) were positive in only the transport media, and 1 (2.4 %) was positive in only the transplant media. Patients with positive transplant media were similar with regard to age, gender, etiology, and disease duration compared to those with negative transplant media (all p > 0.05), but the positive group was more likely to have a pancreatic stent in place at the time of surgery (38.5 % vs. 4.2 %, p = 0.01). The overall postoperative infectious complication rate was 31.2 % (n = 13). No difference was detected between the transplant positive and negative culture groups in postoperative fever or 30-day infectious complications (p > 0.05 for each). Conclusion An existing pancreatic stent at the time of pancreatectomy with IAT is a risk factor for positive sterility cultures. However, positive islet transplant media culture was not associated with increased risk of post-IAT infection or morbidity in the setting of an empiric antibiotic protocol. Future work is necessary to study the optimal perioperative antibiotic regimen in pediatric IAT. Keywords Pancreatitis . Pancreatectomy . Islet autotransplantation . Pediatrics . Infection
Presented at the 2019 Digestive Disease Week/SSAT Annual Meeting, San Diego, CA, May 20, 2019 * Jaimie D. Nathan [email protected] 1
Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, USA
2
Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
3
Division of Pediatric Gastroenterology, Hepat
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