Sorrentino, M.; Capretti, G.; Nappo, G.; Gavazzi, F.; Ridolfi, C.; Pagnanelli, M.; Nebbia, M.; Morelli, P.; Zerbi, A. Origin and Clinical Impact of Early Multidrug-Resistant (MDR) Contamination in Patients Undergoing Pancreaticoduodenectomy. Gastroenterol. Insights2024, 15, 168-178.
Sorrentino, M.; Capretti, G.; Nappo, G.; Gavazzi, F.; Ridolfi, C.; Pagnanelli, M.; Nebbia, M.; Morelli, P.; Zerbi, A. Origin and Clinical Impact of Early Multidrug-Resistant (MDR) Contamination in Patients Undergoing Pancreaticoduodenectomy. Gastroenterol. Insights 2024, 15, 168-178.
Sorrentino, M.; Capretti, G.; Nappo, G.; Gavazzi, F.; Ridolfi, C.; Pagnanelli, M.; Nebbia, M.; Morelli, P.; Zerbi, A. Origin and Clinical Impact of Early Multidrug-Resistant (MDR) Contamination in Patients Undergoing Pancreaticoduodenectomy. Gastroenterol. Insights2024, 15, 168-178.
Sorrentino, M.; Capretti, G.; Nappo, G.; Gavazzi, F.; Ridolfi, C.; Pagnanelli, M.; Nebbia, M.; Morelli, P.; Zerbi, A. Origin and Clinical Impact of Early Multidrug-Resistant (MDR) Contamination in Patients Undergoing Pancreaticoduodenectomy. Gastroenterol. Insights 2024, 15, 168-178.
Abstract
Introduction
Infections caused by multidrug-resistant bacteria (MDR) occur more frequently after pancreaticoduodenectomy (PD) compared to other abdominal surgeries, and infective complications are a leading cause of postoperative morbidity following PD. Pre-operative biliary stent (PBS) placement often leads to biliary contamination, which in turn plays a significant role in postoperative infections. The aim of this study is to evaluate the impact of MDR contamination on short-term postoperative outcomes in patients undergoing PD and to examine the relationship between MDR bacteria, PBS, and bile contamination.
Methods
This is a retrospective study based on a prospectively maintained database comprising 825 consecutive patients who underwent pancreaticoduodenectomy (PD) between January 2010 and December 2020 at our center. All procedures were conducted with a standardized resection by a dedicated group of surgeons in a specialized pancreatic surgery unit, and the patients were managed according to the same perioperative enhanced recovery protocol.
Results
MDR bacteria were present in 17.5% of bile cultures, exclusively within the stented group. In our multivariate analysis, the development of a major postoperative complication (MPC) was correlated with the presence of MDR bacteria in the bile (OR 1.66, 95% CI: 1.1-2.52; p = 0.02). MDR bacteria were detected early in the surgical drainage in 144 out of 825 patients (12.1%), with 72.2% having a previous biliary stent placement and 27.8% without stents (p < 0.001). In our multivariate analysis, the development of an MPC was associated with the presence of MDR bacteria in the drainage (OR=1.81, 95% CI: 1.21-2.73, p= 0.0042).
Conclusions
We demonstrated that MDR contamination worsens the short-term outcomes of patients undergoing PD. Specifically, when MDR bacteria are present in both the bile and drainage, there is a statistically significant increase in the incidence of major postoperative complications (MPC). Our data suggest that the majority of MDR surgical site infections stem from biliary contamination resulting from the placement of a pre-operative biliary stent (PBS).
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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