{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T04:51:53Z","timestamp":1781931113097,"version":"3.54.5"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early drain fluid contamination after pancreaticoduodenectomy (PD) may predict postoperative complications. We investigated the significance of positive drain cultures on postoperative day 1 (POD1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 637 consecutive patients undergoing PD between 2020 and 2024. Patients were divided into POD1 drain culture\u2013positive (PDC) and negative (NDC) groups to assess risk factors and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PDC was identified in 87 patients (14%). In 73% of PDC cases, organisms isolated from POD1 drain cultures matched those from intraoperative bile cultures. Multivariate analysis identified high BMI, biliary tract cancer, soft pancreas, and preoperative biliary drainage as independent risk factors for PDC. Compared with the NDC group, the PDC group had higher rates of Clavien\u2010Dindo grade\u2009\u2265\u2009IIIa complications (40% vs. 15%), clinically relevant postoperative pancreatic fistula (51% vs. 20%), and postpancreatectomy hemorrhage (9% vs. 3%), as well as longer hospital stay (26 vs. 20\u2009days) (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Even among patients with a hard pancreas, PDC was associated with increased major complications (41% vs. 12%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). Among PDC patients, early administration of susceptible antibiotics by POD3 was associated with fewer major complications (25% vs. 62%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Positive POD1 drain cultures predict major complications after PD. Early culture\u2010guided antibiotic therapy may reduce postoperative morbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhbp.70143","type":"journal-article","created":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T04:33:51Z","timestamp":1781930031000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Impact of Early Positive Drain Culture on Outcomes and Management After Pancreaticoduodenectomy"],"prefix":"10.1002","author":[{"given":"Hayato","family":"Baba","sequence":"first","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sho","family":"Kiritani","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Hayama","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Cancer Institute Hospital Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7315-0830","authenticated-orcid":false,"given":"Atsushi","family":"Oba","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1662-5131","authenticated-orcid":false,"given":"Yoshihiro","family":"Ono","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Sato","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research  Tokyo Japan"},{"name":"Department of Gastroenterological Surgery Nagoya City University Graduate School of Medical Sciences  Nagoya Aichi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromichi","family":"Ito","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5812-6608","authenticated-orcid":false,"given":"Yosuke","family":"Inoue","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3066-023X","authenticated-orcid":false,"given":"Yu","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"issue":"1","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/01.sla.0000217673.04165.ea","article-title":"One Thousand Consecutive Pancreaticoduodenectomies","volume":"244","author":"Cameron J. L.","year":"2006","journal-title":"Annals of Surgery"},{"issue":"1","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/SLA.0000000000003451","article-title":"Textbook Outcome: Nationwide Analysis of a Novel Quality Measure in Pancreatic Surgery","volume":"271","author":"Roessel S.","year":"2020","journal-title":"Annals of Surgery"},{"issue":"6","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1097\/01.sla.0000246856.03918.9a","article-title":"Assessment of Complications After Pancreatic Surgery: A Novel Grading System Applied to 633 Patients","volume":"244","author":"DeOliveira M. L.","year":"2006","journal-title":"Annals of Surgery"},{"issue":"3","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.surg.2016.11.014","article-title":"The 2016 Update of the International Study Group (ISGPS) Definition and Grading of Postoperative Pancreatic Fistula: 11\u2009Years After","volume":"161","author":"Bassi C.","year":"2017","journal-title":"Surgery"},{"issue":"5","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.surg.2007.05.005","article-title":"Delayed Gastric Emptying After Pancreatic Surgery: Suggested Definition by the International Study Group of Pancreatic Surgery (ISGPS)","volume":"142","author":"Wente M. N.","year":"2007","journal-title":"Surgery"},{"issue":"5","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/S1499-3872(14)60276-9","article-title":"Post\u2010Pancreaticoduodenectomy Hemorrhage: Risk Factors, Managements and Outcomes","volume":"13","author":"Feng J.","year":"2014","journal-title":"Hepatobiliary & Pancreatic Diseases International"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.ijsu.2018.02.057","article-title":"Contaminated Drainage Fluid and Pancreatic Fistula After Pancreatoduodenectomy: A Retrospective Study","volume":"52","author":"Yamashita K.","year":"2018","journal-title":"International Journal of Surgery"},{"issue":"3","key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1097\/SLA.0b013e318265ef0b","article-title":"Factors Influencing Readmission After Pancreaticoduodenectomy: A Multi\u2010Institutional Study of 1302 Patients","volume":"256","author":"Ahmad S. A.","year":"2012","journal-title":"Annals of Surgery"},{"issue":"4","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1097\/MPA.0b013e31826d3a41","article-title":"Bacterial Contamination in Ascitic Fluid Is Associated With the Development of Clinically Relevant Pancreatic Fistula After Pancreatoduodenectomy","volume":"42","author":"Nagakawa Y.","year":"2013","journal-title":"Pancreas"},{"issue":"3","key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.pan.2017.03.007","article-title":"Abdominal Contamination With \n                     Candida albicans\n                   After Pancreaticoduodenectomy Is Related to Hemorrhage Associated With Pancreatic Fistulas","volume":"17","author":"Sato A.","year":"2017","journal-title":"Pancreatology"},{"issue":"11","key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1002\/jhbp.589","article-title":"Clinical Significance of Drain Fluid Culture After Pancreaticoduodenectomy","volume":"25","author":"Yang F.","year":"2018","journal-title":"Journal of Hepato\u2010Biliary\u2010Pancreatic Sciences"},{"issue":"3","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1002\/bjs5.50272","article-title":"Association of Bacteria in Pancreatic Fistula Fluid With Complications After Pancreatic Surgery","volume":"4","author":"Demir E.","year":"2020","journal-title":"BJS Open"},{"issue":"10","key":"e_1_2_10_14_1","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics11101394","article-title":"A Proposal for a Classification Guiding the Selection of Appropriate Antibiotic Therapy for Intra\u2010Abdominal Infections","volume":"11","author":"Sartelli M.","year":"2022","journal-title":"Antibiotics (Basel)"},{"issue":"1","key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.pan.2023.12.013","article-title":"Clinical Usefulness of Routinely Performed Drain Fluid Cultures After Pancreaticoduodenectomy. A New Ally to Predict Patients' Outcomes?","volume":"24","author":"Ciprani D.","year":"2024","journal-title":"Pancreatology"},{"key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1007\/s00423-025-03621-y","article-title":"Positive Drain Fluid Culture on Postoperative Day One Is Associated With an Increased Risk of Late Postoperative Pancreatic Fistula After Pancreaticoduodenectomy","volume":"410","author":"Tang B.","year":"2025","journal-title":"Langenbeck's Archives of Surgery"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1007\/s00595-019-01885-8","article-title":"Early Postoperative Drainage Fluid Culture Positivity From Contaminated Bile Juice Is Predictive of Pancreatic Fistula After Pancreaticoduodenectomy","volume":"50","author":"Hata T.","year":"2020","journal-title":"Surgery Today"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.surg.2016.03.032","article-title":"Bacterobilia May Trigger the Development and Severity of Pancreatic Fistula After Pancreatoduodenectomy","volume":"160","author":"Ohgi K.","year":"2016","journal-title":"Surgery"},{"issue":"5","key":"e_1_2_10_19_1","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics11050697","article-title":"The Role of Abdominal Drain Cultures in Managing Abdominal Infections","volume":"11","author":"De Waele J. J.","year":"2022","journal-title":"Antibiotics (Basel)"},{"issue":"6","key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1097\/SLA.0000000000001065","article-title":"Pancreatoduodenectomy With Systematic Mesopancreas Dissection Using a Supracolic Anterior Artery\u2010First Approach","volume":"262","author":"Inoue Y.","year":"2015","journal-title":"Annals of Surgery"},{"issue":"11","key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"8871","DOI":"10.1007\/s00464-023-10417-y","article-title":"Laparoscopic Dissection Around the Superior Mesenteric Artery by Left Posterior Approach During Pancreaticoduodenectomy","volume":"37","author":"Sato T.","year":"2023","journal-title":"Surgical Endoscopy"},{"issue":"4","key":"e_1_2_10_22_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/XCS.0000000000000281","article-title":"How Can we Optimize Surgical View During Robotic\u2010Assisted Pancreaticoduodenectomy? Feasibility of Multiple Scope Transition Method","volume":"235","author":"Inoue Y.","year":"2022","journal-title":"Journal of the American College of Surgeons"},{"issue":"2","key":"e_1_2_10_23_1","first-page":"153","article-title":"Practical Guidelines for the Appropriate Use of Prophylactic Antibiotics for Postoperative Infection, 2016","volume":"64","author":"The Japanese Society of Chemotherapy","year":"2016","journal-title":"Japanese Journal of Chemotherapy"},{"key":"e_1_2_10_24_1","volume-title":"Performance Standards for Antimicrobial Susceptibility Testing\u201427th Informational Supplement","author":"Clinical and Laboratory Standards Institute","year":"2017"},{"key":"e_1_2_10_25_1","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1001\/jama.1961.03040420001001","article-title":"The Role of Anesthesia in Surgical Mortality","volume":"178","author":"Dripps R. D.","year":"1961","journal-title":"Journal of the American Medical Association"},{"issue":"2","key":"e_1_2_10_26_1","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey","volume":"240","author":"Dindo D.","year":"2004","journal-title":"Annals of Surgery"},{"key":"e_1_2_10_27_1","doi-asserted-by":"crossref","first-page":"124","DOI":"10.5387\/fms.2020-11","article-title":"Early Intra\u2010Abdominal Infection Following Pancreaticoduodenectomy: Associated Factors and Clinical Impact on Surgical Outcome","volume":"66","author":"Sato N.","year":"2020","journal-title":"Fukushima Journal of Medical Science"},{"key":"e_1_2_10_28_1","doi-asserted-by":"crossref","first-page":"28760","DOI":"10.1038\/s41598-024-80245-0","article-title":"The Clinical Significance of Intraoperative Lavage Fluid Culture During Pancreaticoduodenectomy on Organ\/Space Surgical Site Infection","volume":"14","author":"Yang Y.","year":"2024","journal-title":"Scientific Reports"},{"key":"e_1_2_10_29_1","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/hpb.12012","article-title":"Five Days of Postoperative Antimicrobial Therapy Decreases Infectious Complications Following Pancreaticoduodenectomy in Patients at Risk for Bile Contamination","volume":"15","author":"Sourrouille I.","year":"2013","journal-title":"HPB"},{"key":"e_1_2_10_30_1","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.hpb.2021.06.428","article-title":"The Association Between Bacterobilia and the Risk of Postoperative Complications Following Pancreaticoduodenectomy","volume":"24","author":"Parapini M. L.","year":"2022","journal-title":"HPB"},{"key":"e_1_2_10_31_1","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1001\/jama.2023.5728","article-title":"Piperacillin\u2013Tazobactam vs Cefoxitin as Perioperative Prophylaxis for Pancreatoduodenectomy: A Randomized Clinical Trial","volume":"329","author":"D'Angelica M. I.","year":"2023","journal-title":"Journal of the American Medical Association"}],"container-title":["Journal of Hepato-Biliary-Pancreatic Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jhbp.70143","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jhbp.70143","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jhbp.70143","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T04:34:04Z","timestamp":1781930044000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jhbp.70143"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":30,"alternative-id":["10.1002\/jhbp.70143"],"URL":"https:\/\/doi.org\/10.1002\/jhbp.70143","archive":["Portico"],"relation":{},"ISSN":["1868-6974","1868-6982"],"issn-type":[{"value":"1868-6974","type":"print"},{"value":"1868-6982","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]},"assertion":[{"value":"2026-02-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jhbp.70143"}}