Impact of poly resistant bile flora on the development of infectious complications after pancreatoduodenectomy

Aim: to evaluate the impact of multidrug-resistant bile microflora on the development of infectious complications after pancreatoduodenectomy in patients undergoing standard perioperative antibiotic prophylaxis.

Material and Methods. This retrospective study included patients over 18 years of age who underwent pancreatoduodenectomy from January 2019 until May 2023. The inclusion criteria were the presence of pre/intraoperative bacteriological examination of a bile sample and perioperative antibiotic prophylaxis with amoxicillin + clavulanic acid at a dose of 1 ± 0.2 g 30 minutes before skin incision, followed by intraoperative administration every 4 hours. In the postoperative period, the drug was administered during the day at a dose of 1 ± 0.2 g every 6 hours. Of the 249 operated patients, 57 met the inclusion criteria; they were divided into two groups: patients without resistant strains in the bile and patients with resistant microflora. The postoperative period was assessed by tracking the incidence of surgical site infections (SSI), the likelihood of reoperations, hospitalizations, and one-year survival. Statistical data analysis was carried out using the statistical package R 3.4.2.

Results. The majority of patients – 24 (42 %) had a bile microflora with extended drug resistance, while 19 (33 %) patients had multiple drug resistance. Microflora without clinically significant resistance was found in 11 (25 %) patients, and no bacterial growth in the bile was observed in 3 (5 %) patients. Group 1 included 14 (25 %) and group 2 included 43 (75 %) patients. According to the data obtained, there were no superficial SSIs in patients with non-resistant microflora (group 1), whereas in the group of patients with resistant microflora (group 2) their frequency was 2 %. Organ/cavity SSIs were also observed with greater frequency in group 2 and amounted to 44 % versus 19 % in group 1. The probability of developing a surgical site infection was 28.6 % in group 1, versus 51.7 % in group 2 (p=0.2). There were no statistically significant differences in the re-operation and re-hospitalization rates between the groups (31.2 % for group 1 and 28.3 % for group 2, p=0.66; 5 % for group 1 and 7.4 % for group 2, p=0.42, respectively). No statistically significant difference in the 1-year survival rate between the study groups was found.

Conclusion. Multidrug-resistant microflora represents a serious burden for modern medicine, especially in the context of treating cancer patients requiring complex surgical interventions. Our study highlights the importance of timely monitoring of microflora and revision of approaches to perioperative antibiotic prophylaxis of infectious complications.

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