Multidrug-resistant bacterial colonization affects postoperative outcomes after pancreaticoduodenectomy.

BACKGROUND

Bile colonization after biliary drainage is associated with a greater rate of morbidity and mortality after pancreaticoduodenectomy. The increased use of antibiotics has led to a greater rate of bile colonization by multidrug-resistant microorganisms. This study aimed to analyze the correlation between multidrug-resistant microorganisms and the rate of postoperative complications.

METHODS

Data from patients who underwent pancreaticoduodenectomy between 2016 and 2022 were retrospectively analyzed, and biliary culture data were revised and collected. Microorganisms were defined as sensitive to antibiotics or multidrug-resistant according to the literature.

RESULTS

Overall, 460 patients with intraoperative biliary cultures were included in the study group. Multidrug-resistant microorganisms were isolated from 102 (22%) patients. The presence of multidrug resistance at biliary culture was an independent risk factor for clinically relevant postoperative pancreatic fistula (odds ratio, 2.590; 95% confidence interval, 1.49-4.48, P = .001) and infectious complications (odds ratio, 3.232; 95% confidence interval, 1.99-5.25, P < .001). The isolation of multidrug-resistant microorganisms also increased the final burden of complications. In patients with clinically relevant postoperative pancreatic fistula, the presence of multidrug-resistant microorganisms resulted in a median comprehensive complication index of 47.10 [interquartile range, 36.2-66.6] versus 39.53 [interquartile range, 29.6-54.2], P = .034. Among the different microorganisms, Escherichia coli multidrug resistance and Klebsiella pneumoniae multidrug resistance were significantly associated with pancreatic surgery-specific complications.

CONCLUSION

Multidrug-resistance bile colonization is an independent risk factor for complications after pancreaticoduodenectomy, including clinically relevant postoperative pancreatic fistula. In case of the onset of pancreatic surgery-specific complications, the presence of these microorganisms increases the burden of complications.