Prevention of infectious complications of pancreatoduodenal resections by revising the approach to perioperative use of antibacterial drugs

Aim. To reduce the incidence of postoperative infectious complications after pancreatoduodenal resection using targeted perioperative antibiotic therapy.

Materials and methods. The retrospective study included patients who had undergone pancreatoduodenal resection between 2019 and May 2023. The inclusion criterion was bacteriological examination of bile obtained both before and du­ring surgery. Of the 249 patients who had undergone surgery, 108 were included in the study. The patients were divided into two groups: those with antibiotic-sensitive flora and those with resistant flora. Infectious complications were determined according to the criteria of the Russian National Association of Healthcare-Associated Infection Control Professionals. The probability of developing an infection and the need for repeat surgery or hospital readmission was assessed.

Results. The probability of developing infectious complications in the group of patients with resistant flora was 57.5%, compared to 15% in the group with sensitive flora (p < 0.0001). The multivariate analysis found that baseline antibiotic resistance of bile bacterial flora and body mass index are independent predictors of the risk of infectious complications after pancreatoduodenal resection: HR = 5.17 (95% CI 2.15–12.5, p < 0.001) and 1.10 (95% CI 1.03–1.18, p = 0.007).

Conclusion. Targeted perioperative use of antibiotics, taking the sensitivity of the bacterial flora of bile into account, contributes to a reduction in the frequency of infectious complications of pancreatoduodenal resection.

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