Impact of multidrug-resistant microorganisms in bile on postoperative outcomes and long-term survival in patients with periampullary malignancies.

Preoperative biliary drainage (PBD) and antibiotic therapy due to cholangitis contribute toward bile contamination with multidrug-resistant organisms (MDROs) and increase the risk of infectious complications. However, little is known about the impact of MDROs in bile on postoperative outcomes and long-term survival in patients with periampullary malignancies. This retrospective single-center study investigated the impact of bile contamination with MDROs on the incidence, postoperative outcomes, and long-term survival in periampullary malignancies in a German tertiary pancreatic center between 2011 and 2015. A total of 428 patients underwent curative and palliative surgery for periampullary malignancies. At least one multidrug-resistant organism in bile was detected in 72 cases (16.8%). Patients with MDROs were significantly older, had a higher frequency of PBD, preoperative antibiotic therapies, non-standard single-shot antibiotics perioperatively, and prolonged antibiotic therapy postoperatively as opposed to the non-MDRO group. The incidence of surgical site infection was significantly higher in the MDRO group. Survival in papillary cancer was significantly worse in the MDRO group compared to the non-MDRO group. Patients with postoperative sepsis had significantly higher risk (hazard ratio 4.59) for postoperative death. Bile contamination with MDROs is associated with a significant increase of surgical site infection, leading to high mortality and poor long-term survival. Tailored antibiotic therapy may improve the survival rate.