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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 10/2020

01-10-2020 | Pancreatoduodenostomy | Original Article

The Relative Role of Bile Bacterial Isolation on Outcome in Stent-Bearing Patients Undergoing Pancreatoduodenectomy

Authors: Marta Sandini, Kim C. Honselmann, Marco Cereda, Marco Angrisani, Francesca Gavazzi, Ulrich Wellner, Louisa Bolm, Tobias Keck, Alessandro Zerbi, Luca Gianotti

Published in: Journal of Gastrointestinal Surgery | Issue 10/2020

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Abstract

Background

Biliary stenting leads to antimicrobial-resistant (AMR) microorganism retrievement in bile cultures. However, the impact of intraoperative bile colonizations on post-pancreaticoduodenectomy complications remains unclear. Aims of our study were to characterize the bile flora of stented patients in comparison with postoperative cultures and to analyze whether patterns of drug resistance affected postoperative outcomes.

Methods

We analyzed records from stent-bearing pancreaticoduodenectomy patients at 3 European centers. Intra- and postoperative cultures were compared and classified as multidrug sensitive (MDS), multidrug resistant (MDR), and extensively drug resistant (XDR). Thirty-day complications were graded according to international standards.

Results

Out of 270 patients, intraoperative cultures were positive in 219 (81.1%) cases. In 36.7%, MDS species were isolated; in 35.9%, MDR; and in 8.5%, XDR species. A solid correspondence between the species isolated intra- and postoperatively (p < 0.001) was observed. Intraoperative MDR/XDR isolation was associated with an increased rate of surgical (p = 0.043) and infectious complications (p = 0.030), but not severe complication rate (p = 0.973). Postoperative MDR/XDR isolation was associated with higher risk of major complications (45.6% vs. 15.8%, p < 0.001), postoperative pancreatic fistula (p < 0.001), and post-pancreatectomy hemorrhage (p = 0.002). By multivariate analysis, intraoperative AMR isolation was associated with high likelihood of postoperative AMR infections. However, only in 43/121 cases, intraoperative MDR/XDR microorganisms turned into the occurrence of postoperative infections.

Conclusion

Intraoperative AMR isolates do not translate into severe outcomes, despite being significantly associated with surgical and infectious complications.
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Metadata
Title
The Relative Role of Bile Bacterial Isolation on Outcome in Stent-Bearing Patients Undergoing Pancreatoduodenectomy
Authors
Marta Sandini
Kim C. Honselmann
Marco Cereda
Marco Angrisani
Francesca Gavazzi
Ulrich Wellner
Louisa Bolm
Tobias Keck
Alessandro Zerbi
Luca Gianotti
Publication date
01-10-2020
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 10/2020
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-019-04388-6

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