AN ANTIMICROBIAL STEWARDSHIP PROGRAM IN PANCREATIC SURGERY REDUCES THE INFECTIOUS RISK OF COLONIZED BILE, REDUCING THE PREDICTIVE VALUE OF THE INTRAOPERATIVE BILE CULTURE – A BEFORE-AFTER STUDY ON 1638 PANCREATODUODENECTOMIES salvatore.paiella@univr.it

 

AN ANTIMICROBIAL STEWARDSHIP PROGRAM IN PANCREATIC SURGERY REDUCES THE INFECTIOUS RISK OF COLONIZED BILE, REDUCING THE PREDICTIVE VALUE OF THE INTRAOPERATIVE BILE CULTURE – A BEFORE-AFTER STUDY ON 1638 PANCREATODUODENECTOMIES

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Italy

Oral only

SSI negatively impact the surgical course of patients undergoing pancreaticoduodenectomy. Multidrug-resistant bacteria typically colonize the bile when a stent is in place. The study evaluated the impact on SSI of an antimicrobial stewardship program in pancreatic surgery.

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.

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).

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.