Microbiologic Changes Induced by Biliary Drainage Require Adapted Antibiotic Prophylaxis during Duodenopancreatectomy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Microbiology

Background:

• Periampullary tumors often necessitate pre-operative endoscopic biliary investigations and drainage (BD).
• Recent studies indicate a shift in the biliary microbiome towards resistant bacteria following BD.
• Understanding these microbiome alterations is vital for optimizing peri-operative care.

Purpose of the Study:

• To evaluate the local biliary microbiome in patients with periampullary tumors.
• To assess changes in the microbiome induced by biliary drainage (BD) and antibiotic exposure.
• To inform the selection of appropriate antibiotics for peri-operative prophylaxis.

Main Methods:

• Retrospective cohort study of 37 patients undergoing surgery for periampullary tumors (2013-2017).
• Intra-operative bile samples collected for culture.
• Analysis of pre-operative, intra-operative, and post-operative antibiotic use and complications (Dindo-Clavien classification).

Main Results:

• Bacterial contamination was significantly higher in the BD group (93%) compared to the no biliary drainage (NBD) group (38%).
• A notable shift in microbiome composition was observed in the BD group, with increased prevalence of Enterococcus species and Candida albicans.
• Despite microbiome changes, no significant differences in post-operative complications or stay were found between BD and NBD groups.

Conclusions:

• Pre-operative biliary investigations and drainage with antibiotic prophylaxis induce significant changes in the biliary microbiome, favoring enterococci and fungi.
• Systematic intra-operative bile sampling is recommended for periampullary tumor surgery to guide antibiotic therapy.
• Peri-operative antibiotic prophylaxis strategies may require adaptation to address the altered microbiome.