Early Infectious Complications After Total Pancreatectomy with Islet Autotransplantation: a Single Center Experience

• Published in: Journal of gastrointestinal surgery Vol. 23; no. 11; pp. 2201 - 2210
• Main Authors: Gołębiewska, Justyna E., Bachul, Piotr J., Fillman, Natalie, Kijek, Mark R., Basto, Lindsay, Para, Monica, Perea, Laurencia, Gołąb, Karolina, Wang, Ling-jia, Tibudan, Martin, Dębska-Ślizień, Alicja, Matthews, Jeffrey B., Fung, John, Witkowski, Piotr
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2019; Springer Nature B.V
• Subjects: Adolescent; Adult; Child; Female; Follow-Up Studies; Gastroenterology; Gastrointestinal surgery; Humans; Incidence; Infections; Islets of Langerhans Transplantation - adverse effects; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pancreas; Pancreatectomy; Pancreatectomy - adverse effects; Pancreatitis, Chronic - surgery; Pathogens; Surgery; Surgical outcomes; Surgical Wound Infection - diagnosis; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Time Factors; Transplantation, Autologous; United States - epidemiology; Young Adult; United States; Surveillance cultures; Autologous islet transplantation; Infectious complications; Total pancreatectomy with islet autotransplantation
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-019-04118-y

Introduction We assessed whether positive microbiological cultures from the islet preparation had any effect on the risk of infectious complications (IC) after total pancreatectomy with islet autotransplantation (TPIAT) in our center. Methods We analyzed preservation fluid and final islet product surveillance cultures with reference to clinical data of patients undergoing TPIAT. All patients received routine prophylactic broad-spectrum antibiotics. Results The study involved 10 men and 18 women with a median age of 39 years. Over 30% of surveillance cultures during pancreas processing grew bacterial strains with predominantly polymicrobial contaminations (13 of 22 (59%)). At least one positive culture was identified in almost half of the patients (46%) undergoing TPIAT and a third had both surveillance cultures positive. Infectious complications affected 50% of patients. After excluding cases of PICC line-associated bacteremia/fungemia present on admission, incidence of IC was higher in cases of positive final islet product culture than in those with negative result (57% vs. 21%), which also corresponded with the duration of chronic pancreatitis ( p  = 0.04). Surgical site infections were the most common IC, followed by fever of unknown origin. There was no concordance between pathogens isolated from the pancreas and those identified during the infection . Conclusions While IC was common among TPIAT patients, we found no concordance between pathogens isolated from the pancreas and those identified during infection. Contamination of the final islet product was of clinical importance and could represent a surrogate marker for higher susceptibility to infection.