Association between postoperative Clostridioides difficile infection and outcomes following pancreatoduodenectomy for pancreatic cancer: a national cohort study.

BACKGROUND

Clostridioides difficile infection (CDI) is a major healthcare-associated infection, but its impact after pancreatoduodenectomy (PD) for pancreatic cancer is unclear. This study assessed the incidence of CDI after PD for pancreatic cancer and evaluated preoperative factors associated with CDI, as well as the relationship between CDI and postoperative morbidity and mortality.

METHODS

A retrospective cohort study using the ACS-NSQIP database included patients who underwent PD for pancreatic head cancer. Patients were stratified by postoperative CDI, and univariate and multivariate logistic regression analyses identified risk factors and outcomes.

RESULTS

Among 16,757 patients, 249 (1.5%) developed postoperative CDI. Multivariate analysis showed increasing age (OR 1.21, p = 0.02), lower body weight (OR 0.95, p = 0.01), and recent chemotherapy (OR 1.47, p = 0.01) as independent predictors of postoperative CDI. Postoperative CDI was significantly associated with increased odds of composite morbidity (OR 1.62, p = 0.02), sepsis (OR 1.62, p = 0.02), pancreatic fistula (OR 2.01, p < 0.001), delayed gastric emptying (OR 1.79, p = 0.001), organ-space surgical site infection (OR 1.99, p < 0.001), wound disruption (OR 3.91, p < 0.001), and septic shock (OR 2.24, p = 0.007).

CONCLUSION

Although uncommon, CDI after PD was associated with increased morbidity in this cohort. Older patients, those with lower body weight, and patients receiving chemotherapy had higher odds of postoperative CDI and may benefit from close clinical monitoring and judicious antibiotic stewardship.