Risk factors and microbial spectrum for infectious complications after pancreaticoduodenectomy

Abstract

Background: Although the mortality of pancreaticoduodenectomy (PD) has decreased, the morbidity especially infections is still a severe challenge. This study aimed to identify the risk factors and microbial spectrum for infectious complications after PD.Methods: This retrospective study of 291 consecutive patients who underwent PD between February 2018 and March 2021 was conducted. The clinical data was reviewed and risk factors associated with infectious complications were analyzed. To investigate the microbial spectrum, microorganisms isolated from preoperative bile, drainage fluid and blood were counted.Results: A total of 110 patients (37.8%) developed postoperative infections. The patients who suffered infections had higher severe complications, prolonged hospitalization and increased expenditures. Three independent risk factors were identified: preoperative biliary drainage (PBD) [odds ratio (OR) 2.082; 95% confidence interval (CI): 1.059-4.091; P=0.033], clinically relevant postoperative pancreatic fistula (CR-POPF) (OR 11.984; 95% CI: 6.556-21.471; P=0.000) and biliary fistula (BF) (OR 3.674; 95% CI: 1.218-11.084; P=0.021). K. pneumoniae and E. faecalis were the most frequently isolated bacteria in preoperative bile and drainage fluid after PD. K. pneumoniae and S. haemolyticus were the most common bacteria in bacteremia patients.Conclusions: PBD, POPF and BF are independent risk factors for infectious complications after PD. To lower the incidence of infection, PBD should be performed only in select cases and efforts should be taken to reduce the POPF and BF. The pathogens of bile and drainage fluid should be monitored throughout the hospital stay.

Epidemiology of healthcare‐associated infections and outcomes among open and robotic pancreatoduodenectomy: A retrospective study from 2013 to 2022

“…In this study, the overall incidence of postoperative HAIs from 2013 to 2022 was 8.7%, which was lower than the results in other studies (approximately 17.2-37.8%) [22][23][24] and showed a decreasing trend. The disparity in these findings could be attributed to variations in HAIs prevention and control measures.…”

The Impact of Preoperative Biliary Drainage on Postoperative Healthcare-Associated Infections and Clinical Outcomes Following Pancreaticoduodenectomy: A Ten-Year Retrospective Analysis

“…As reported in previous studies, Klebsiella pneumoniae, Enterococcus and Escherichia coli were the most common pathogens in postoperative HAIs populations who underwent PD in this study [32,33]. This indicates the importance of targeted prophylactic antibiotic use in clinical practice, particularly focusing on these pathogenic organisms.…”

Predictive Value of Body Composition Parameters for Postoperative Complications in Patients Who Received Pancreaticoduodenectomy

“…As anticipated, the elderly were more susceptible to fatigue, and the mean age was older in the sarcopenia and myosteatosis groups. Furthermore, Fu et al [21] observed that preoperative biliary drainage raised the incidence of SSI because the duodenum and biliary tree were directly connected and thereby contaminated with an indwelling tube. In our study, 54.3% of the patients were jaundiced and 65% of them received preoperative biliary drainage, undoubtedly contributing to the high postoperative SSI rate.…”

“…7 [34.8-39.4] g/L vs. 38.4 [36.4-40.5] g/L; p = 0.013) and higher CRP level (6.5 [4.2-34.6] g/L vs. 4.7 [2.9-9.8] g/L; p = 0.007) (Table 3). The incidences of CR-POPF (53.2% vs. 31.7%; p = 0.016), major complications (36.2% vs. 4.8%; p = 0.001), PLOS (22 [17-33] d vs. 17 [14][15][16][17][18][19][20][21][22][23] d; p = 0.002), and CCI score (34.8 [24.2-39.2] vs. 25.7 [19.4-32]; p = 0.001) were all increased in sarcopenic patients. Significant sex differences were found in the visceral obesity group (33 men vs. 5 women; p = 0.001) and the BMI was higher (26.1 ± 3.5 kg/m 2 vs. 22.1 ± 2.4 kg/m 2 ; p = 0.001).…”