Background: Pancreatic surgery is characterized by high morbidity and mortality. Biliary colonization may affect clinical outcomes in these patients. Aims: This study aimed to verify whether bacteriobilia and multidrug resistance (MDR) detected during and after pancreatic surgery may have an impact on post-operative outcomes. Methods: Data from patients undergoing pancreatic surgery involving bile duct transection (2016-2022) in two high-volume centers were analyzed in relationship to overall morbidity, major morbidity and mortality after pancreato-duodenectomy (PD) or total pancreatectomy (TP). Simple and multivariable regressions were used. Results: 227 patients submitted to PD (n=129) or TP (n=98) were included. Of them, 133 had preoperative biliary drainage (BD; 56.6%), mostly with the employment of endoscopic stents (91.7%). Bacteriobilia was detected in 111 patients (48.9%), and remarkably, observed in patients with BD (p=0.001). In addition, 25 MDR pathogens were identified (22.5%), with a significant prevalence in patients with BD. Multivariable regression analysis showed BD was strongly related to MDR isolation (odds ratio [OR]: 5.61; p=0.010). MDR isolation was the main factor linked to a higher number of major complications (OR: 2.75; p=0.041), including major infection complications (OR: 2.94; p=0.031). Conclusions: Isolation of MDR from biliary swab during PD or TP significantly increases the risk of a worse post-operative outcome. Pre-operative precautions could improve patient safety.
Alarming correlation between multidrug-resistant bacteriobilia and morbidity after pancreatic surgery / Gibiino, Giulia; Cucchetti, Alessandro; Mocchegiani, Federico; Bocchino, Antonio; Gaudenzi, Federico; Binda, Cecilia; Raumer, Luigi; Fabbri, Carlo; Cristini, Francesco; Vivarelli, Marco; Ercolani, Giorgio. - In: DIGESTIVE AND LIVER DISEASE. - ISSN 1878-3562. - (2023). [10.1016/j.dld.2023.05.012]