Multidrug-resistant bacterial colonization affects postoperative outcomes after pancreaticoduodenectomy.

IF 2.7 2区医学 Q1 SURGERY

Surgery Pub Date : 2025-10-01 Epub Date: 2025-08-08 DOI:10.1016/j.surg.2025.109594

Domenico Tamburrino, Giovanni Guarneri, Lorenzo Provinciali, Giuseppe Vanella, Matteo Tacelli, Livia Archibugi, Marcella Negri, Marco Ripa, Gabriele Capurso, Paolo Giorgio Arcidiacono, Antonella Castagna, Nicolò Pecorelli, Stefano Crippa, Stefano Partelli, Massimo Falconi

{"title":"Multidrug-resistant bacterial colonization affects postoperative outcomes after pancreaticoduodenectomy.","authors":"Domenico Tamburrino, Giovanni Guarneri, Lorenzo Provinciali, Giuseppe Vanella, Matteo Tacelli, Livia Archibugi, Marcella Negri, Marco Ripa, Gabriele Capurso, Paolo Giorgio Arcidiacono, Antonella Castagna, Nicolò Pecorelli, Stefano Crippa, Stefano Partelli, Massimo Falconi","doi":"10.1016/j.surg.2025.109594","DOIUrl":null,"url":null,"abstract":"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.","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"109594"},"PeriodicalIF":2.7000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.surg.2025.109594","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/8 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

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.

查看原文本刊更多论文

多药耐药细菌定植影响胰十二指肠切除术后的预后。

背景：胆道引流后胆汁定殖与胰十二指肠切除术后更高的发病率和死亡率相关。抗生素使用的增加导致耐多药微生物在胆汁中定植的比例增加。本研究旨在分析耐多药微生物与术后并发症发生率的相关性。方法：回顾性分析2016年至2022年行胰十二指肠切除术患者的资料，并对胆道培养资料进行修订和收集。根据文献，微生物被定义为对抗生素敏感或多重耐药。结果：总共有460例术中胆道培养患者被纳入研究组。从102例（22%）患者中分离出耐多药微生物。胆道培养中出现多药耐药是临床相关术后胰瘘的独立危险因素(优势比，2.590；95%可信区间，1.49 ~ 4.48,P = .001)和感染性并发症(优势比，3.232；95%置信区间为1.99 ~ 5.25,P < 0.001)。多重耐药微生物的分离也增加了并发症的最终负担。在具有临床相关性的术后胰瘘患者中，多药耐药微生物的存在导致综合并发症指数中位数为47.10[四分位数范围，36.2-66.6]对39.53[四分位数范围，29.6-54.2],P = 0.034。在不同的微生物中，大肠杆菌多药耐药和肺炎克雷伯菌多药耐药与胰腺手术特异性并发症显著相关。结论：多药耐药胆汁定殖是胰十二指肠切除术后并发症的独立危险因素，包括临床相关的术后胰瘘。在发生胰腺手术特异性并发症的情况下，这些微生物的存在增加了并发症的负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.