Multidrug-resistant bacterial colonization affects postoperative outcomes after pancreaticoduodenectomy

Background: Bile colonization after biliary drainage is associated with a greater rate of morbidity and mortality after pancreaticoduodenectomy. The increased use of antibiotics has led to a greater rate of bile colonization by multidrug-resistant microorganisms. This study aimed to analyze the correlation between multidrug-resistant microorganisms and the rate of postoperative complications. Methods: Data from patients who underwent pancreaticoduodenectomy between 2016 and 2022 were retrospectively analyzed, and biliary culture data were revised and collected. Microorganisms were defined as sensitive to antibiotics or multidrug-resistant according to the literature. Results: Overall, 460 patients with intraoperative biliary cultures were included in the study group. Multidrug-resistant microorganisms were isolated from 102 (22%) patients. The presence of multidrug resistance at biliary culture was an independent risk factor for clinically relevant postoperative pancreatic fistula (odds ratio, 2.590; 95% confidence interval, 1.49-4.48, P = .001) and infectious complications (odds ratio, 3.232; 95% confidence interval, 1.99-5.25, P < .001). The isolation of multidrug-resistant microorganisms also increased the final burden of complications. In patients with clinically relevant postoperative pancreatic fistula, the presence of multidrug-resistant microorganisms resulted in a median comprehensive complication index of 47.10 [interquartile range, 36.2-66.6] versus 39.53 [interquartile range, 29.6-54.2], P = .034. Among the different microorganisms, Escherichia coli multidrug resistance and Klebsiella pneumoniae multidrug resistance were significantly associated with pancreatic surgery-specific complications. Conclusion: Multidrug-resistance bile colonization is an independent risk factor for complications after pancreaticoduodenectomy, including clinically relevant postoperative pancreatic fistula. In case of the onset of pancreatic surgery-specific complications, the presence of these microorganisms increases the burden of complications.