The Relative Role of Bile Bacterial Isolation on Outcome in Stent-Bearing Patients Undergoing Pancreatoduodenectomy
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ORIGINAL ARTICLE
The Relative Role of Bile Bacterial Isolation on Outcome in Stent-Bearing Patients Undergoing Pancreatoduodenectomy Marta Sandini 1 & Kim C. Honselmann 2 & Marco Cereda 1,3 & Marco Angrisani 1 & Francesca Gavazzi 3 & Ulrich Wellner 2 & Louisa Bolm 2 & Tobias Keck 2 & Alessandro Zerbi 3 & Luca Gianotti 1 Received: 11 March 2019 / Accepted: 28 August 2019 # 2019 The Society for Surgery of the Alimentary Tract
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. Keywords Pancreatoduodenectomy . Biliary stent . Antimicrobial resistance . Infectious complications . Outcomes
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-019-04388-6) contains supplementary material, which is available to authorized users. * Luca Gianotti [email protected] 1
School of Medicine and Surgery, Department of Surgery, San Gerardo Hospital, Milano Bicocca University, Monza, Italy
2
Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
3
Pancreatic Surgery Unit, Department of Surgery, Humanitas Research Hospital and University, Rozzano, Milan, Italy
The recent improvements in techniques and health care quality for elective surgical proced
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