Perioperative multidrug-resistant bacteria impair clinical outcome after pancreatic surgery: Missed targets of antibiotic prophylaxis.

Abstract

Multidrug-resistant bacteria represent major concerns in perioperative medicine. The extent to which preoperative colonization and postoperative detection of multidrug-resistant bacteria affect outcome in pancreatic surgery is largely unknown. Microbiome analyses provide insights into appropriate perioperative antibiotic prophylaxis. This was a retrospective, single-center cohort study of patients who underwent elective pancreatic surgery between January 2018 and December 2022 with a complete set of preoperative screening swabs. Of 212 patients, n = 168 (79.25%) were classified as multidrug-resistant negative, whereas 44 (20.75%) were tested multidrug-resistant positive perioperatively. Among these, 19 had preoperative detection of multidrug-resistant bacteria and 25 had postoperative detection of multidrug-resistant bacteria. No differences in baseline characteristics were observed. Inflammatory parameters, including blood leukocytes and C-reactive protein, were elevated perioperatively in patients who were multidrug-resistant positive. Postoperative outcomes were significantly impaired in patients who were multidrug-resistant positive compared with those who were multidrug-resistant negative, including greater rates of pancreatic fistula (grade B/C), postpancreatectomy hemorrhage, and reoperation (all P < .0001). Major complication rates, length of intensive care, and in-hospital stay were increased (all P < .0001). Progression of pancreatic fistula to hemorrhage and reoperation was particularly high in patients who were multidrug-resistant positive (37.84% vs 3.92%; P < .0001). Subgroup analyses revealed no differences in postoperative outcomes between patients who were preoperatively tested multidrug-resistant positive and those who were postoperatively tested multidrug-resistant positive. High intrinsic or acquired bacterial resistance rates were observed against commonly used perioperative antibiotics in pancreatic surgery, including metronidazole/second-generation cephalosporins or piperacillin/tazobactam. Both preoperative and postoperative colonization with multidrug-resistant bacteria have deleterious effects on postoperative outcomes. Pancreatic fistula is a crucial cause for severe morbidity in patients who are multidrug-resistant positive. Preoperative decolonization, broad-spectrum perioperative antibiotic prophylaxis, and continued postoperative antibiotics should be considered for high-risk pancreatic surgery patients.