Risk factors and microbial spectrum for infectious complications after pancreaticoduodenectomy

Abstract

Background: Although the mortality of pancreaticoduodenectomy (PD) has decreased, the morbidit especially infections is still a severe challenge. This study aimed to identify the risk factors and microbi spectrum for infectious complications after PD. Methods: This retrospective study of 291 consecutive patients who underwent PD between Februar 2018 and March 2021 was conducted. The clinical data was reviewed and risk factors associated wit infectious complications were analyzed. To investigate the microbial spectrum, microorganisms isolated from preoperative bile, drainage fluid and blood were counted. Results: A total of 110 patients (37.8%) developed postoperative infections. The patients who suffere infections had higher severe complications, prolonged hospitalization and increased expenditures. Thre independent risk factors were identified: preoperative biliary drainage (PBD) [odds ratio (OR) 2.082; 95% confidence interval (CI): 1.059-4.091; P=0.033], clinically relevant postoperative pancreatic fistula (CR POPF) (OR 11.984; 95% CI: 6.556-21.471; P=0.000) and biliary fistula (BF) (OR 3.674; 95% CI: 1.218 11.084; P=0.021). K. pneumoniae and E. faecalis were the most frequently isolated bacteria in preoperative bi and drainage fluid after PD. K. pneumoniae and S. haemolyticus were the most common bacteria in bacterem patients. Conclusions: PBD, POPF and BF are independent risk factors for infectious complications after PD. T lower the incidence of infection, PBD should be performed only in select cases and efforts should be take to reduce the POPF and BF. The pathogens of bile and drainage fluid should be monitored throughout th hospital stay.