Microbial Colonization of Pancreatic Duct Stents

Abstract

Microbial analysis of pancreatic duct stents revealed a very high colonization rate. Furthermore, the spectrum and number of microorganisms altered with the indwelling time of the stent. However, clinical relevance of our findings remains unclear.

The impact of bacterial colonization on graft success after total pancreatectomy with autologous islet transplantation: considerations for early definitive surgical intervention

“…A recent study by Schneider et al. found gram‐negative organisms such as Enterobacteriaceae were significantly more prevalent on stents with a longer indwelling time . Although not statistically significant in this study, patients with bacterial contamination experienced a longer median duration of chronic pancreatitis (6.3 vs 3.9 years, P =.30), a factor that may have contributed to the number of Enterobacteriaceae isolated in culture.…”

“…Studies have demonstrated the sterility and antimicrobial capacity of pancreatic fluid, and researchers have postulated that any bacterial colonization of pancreatic tissue is likely due to iatrogenic manipulation of the pancreatic duct . Ascending bacterial colonization can occur through retrograde migration from the intestinal lumen (more likely after pancreatic surgery) or through the formation of a biofilm on the surface of pancreatic duct stents . More specifically, a recent study by Hill et al .…”

“…Another factor, longer duration of chronic pancreatitis, has been associated with lower islet yield and worse metabolic outcomes . This phenomenon could be due to a multitude of factors including pancreatic burnout and β‐cell death, greater number of endoscopic interventions, longer indwelling duration of stents (regardless of number), or persistent colonization due to the reduced inherent antimicrobial capabilities of patients with chronic pancreatitis . The confounding variable of duration may explain the lower islet yield in patients with bacterial colonization and subsequent rates of insulin independence; however, many studies’ data have disputed the causal relationship of islet yield and insulin independence .…”

Disturbances of the Perioperative Microbiome Across Multiple Body Sites in Patients Undergoing Pancreaticoduodenectomy

“…Klebsiella species (most commonly K. pneumonia and K. oxytoca ) are ubiquitous gram-negative organisms that cause nosocomial infections in humans 25 and commonly harbor genes for antibiotic resistance 26 . Several prior studies of the microbiology of the jejunum 18 , biliary tree 8,27–31 , and pancreas 7 also identified an abundance of Klebsiella in patients with gallstone disease, cholangitis, and cancer. This pattern of results suggests that conditions within the pancreas and biliary tree are favorable for colonization by Klebsiella species, particularly in the setting of disease.…”

“…It has been clearly shown that enteric or biliary microbes can colonize the inflamed pancreas in experimental models 5 . Similarly, it has been shown that the pancreatic duct or stents within the duct in the setting of chronic pancreatitis contain a rich biofilm containing bacteria 6,7 . The bile duct has also been considered to be generally sterile 6 but a number of studies have demonstrated the presence of bacteria in the biliary system in the setting of bile duct obstruction 6,8,9 .…”