Mortality analysis of Aeromonas hydrophila infection in hepato-biliary pancreatic surgery: multicenter retrospective observational study.

BACKGROUND/PURPOSE Aeromonas hydrophila can cause lethal infectious complications after surgery. There have been no large cohort studies of this specific to the hepato-biliary-pancreatic (HBP) field. We investigate the postoperative influence of A. hydrophila infection after HBP surgery. METHODS We retrospectively reviewed patients who underwent HBP surgery between 2008 and 2017 at eight university hospitals. Patients with A. hydrophila isolation during perioperative management were extracted, and their postoperative courses were investigated. RESULTS Bacterial culture examination of 10,074 patients was performed as perioperative management. Among them, 76 patients (0.75%) had A. hydrophila isolation, most of whom underwent pancreatoduodenectomy (n=38) or hepatectomy with biliary reconstruction (n=14). There were seven mortalities after these two procedures (13.5%), five within three days after the onset of infection. Bile (n=48) and abdominal drainage fluid (n=29) were major sites of A. hydrophila isolation. Typical prophylactic antibiotics, cefazolin or flomoxef, were mostly resistant. There was no mortality among patients that received sensitive antibiotics prophylactically. CONCLUSIONS Isolation of A. hydrophila was low in our cases of HBP surgery, but the condition of some patients deteriorated rapidly by this infection. Although there could be several bacterial infections during management of HBP surgery, A. hydrophila should not be overlooked. Preparation of appropriate prophylactic antibiotics may prevent or reduce mortality.