Alarming correlation between multidrug-resistant bacteriobilia and morbidity after pancreatic surgery

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 mortal-ity 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 preop-erative biliary drainage (BD; 56.6%), mostly with the employment of endoscopic stents (91.7%). Bacteri-obilia 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.(c) 2023 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.