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Article Abstract
Objective: Evaluation of pancreatic surgery-specific antimicrobial stewardship (AMS) program on surgical site infections (SSI), focusing on bile microbiology and colonization.
Summary Of Background Data: Colonized bile is well known to increase the risk of SSIs after pancreatoduodenectomy (PD). However, AMS programs seem to reduce their occurrence.
Methods: This observational before-after study included patients who underwent PD from 2015 to 2022 at a high-volume pancreatic center (#NCT04199494). Pre-AMS data spanned from January 2015 to November 2019, and post-AMS data from December 2019 to October 2022. Intraoperative bile samples were analyzed for microbiology. The AMS program involved preoperative rectal screening for multidrug-resistant bacteria to guide personalized surgical antibiotic prophylaxis (SAP). Tailored SAP was used for patients colonized with resistant pathogens. SSI rates, length of stay, major and pancreatic surgery-specific complications, and mortality were assessed using standard statistics.
Results: Of 1,638 patients included, 1,321 (80.6%) had intraoperative bile sampling, with 909 samples (68.8%) testing positive for colonization. The most common bacteria were Enterobacterales (75%), 18% ESBL-producing, and Enterococci (60%), 4% of which were vancomycin-resistant. Colonized bile was associated with male gender, jaundice, biliary stenting, and positive rectal screening (P<0.05). Before AMS, colonized bile correlated with higher SSI rates (38% vs. 31%, P=0.008). Post-AMS, no significant difference was observed (29% vs. 28%, P=0.5). Tailored SAP reduced overall SSI (34% reduction, P=0.002) and superficial SSI (59% reduction, P=0.011).
Conclusions: Pancreatic surgery-specific AMS with tailored SAP reduces SSIs and diminishes the predictive value of colonized bile for SSIs. Intraoperative bile cultures remain valuable for postoperative management.
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