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Updated: Dec 10, 2025
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Published on: March 12, 2019
High risk pathogens and risk factors for postoperative pancreatic fistula after pancreatectomy; a retrospective
Kodai Abe1, Minoru Kitago1, Masahiro Shinoda1
1Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Background:
Although the rates of surgical site infection are decreasing, surgical site infection after pancreatectomy remains frequent because of postoperative pancreatic fistula. Recent studies suggested a relationship between postoperative pancreatic fistula and pathogens cultured from drainage fluids after pancreatectomy. This study aimed to assess and evaluate high-risk pathogens cultured from postoperative drainage fluids for postoperative pancreatic fistulas or severe postoperative complications after pancreatectomy.
Materials And Methods:
We retrospectively enrolled patients who underwent pancreaticoduodenectomy or distal pancreatectomy between 2012 and 2019. We assessed clinical characteristics and microbiological results of drainage cultures of pancreaticoduodenectomy or distal pancreatectomy patients, and we investigated the risk factors for clinically relevant postoperative pancreatic fistulas and Clavien-Dindo status using univariate and multivariate analyses. Finally, we detected high-risk pathogens from drainage cultures and analyzed the correlation between these pathogens and the severity of clinically relevant postoperative pancreatic fistula or Clavien-Dindo status.
Results:
Four hundred and twenty-nine patients were enrolled: 257 underwent pancreaticoduodenectomy and 172 underwent distal pancreatectomy. Clinically relevant postoperative pancreatic fistulas and Clavien-Dindo status ≥ III were more frequently seen in pancreaticoduodenectomy patients than in distal pancreatectomy patients, namely grade C postoperative pancreatic fistula, which was observed in 19 pancreaticoduodenectomy patients. The most common pathogen found from drainage cultures was Enterococcus species, followed by Enterobacter species and Candida species. All pathogens were associated with clinically relevant postoperative pancreatic fistulas; however, Candida species was a dominant microorganism of clinically relevant postoperative pancreatic fistulas grade C, Clavien-Dindo status ≥ IV, and hemorrhage due to pseudoaneurysm.
Conclusion:
The presence of Candida species in the drainage fluid culture after pancreaticoduodenectomy can be a predictive factor of severe infectious complications, including postoperative pancreatic fistulas; thus, we should regularly collect cultures from drainage fluids and monitor for Candida infection.
Insights
High-risk pathogens like Candida species in drainage fluid after pancreatectomy predict severe complications, including pancreatic fistulas. Monitoring these infections is crucial for patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Infectious Diseases
Background:
- Surgical site infections after pancreatectomy are often linked to postoperative pancreatic fistulas.
- Identifying pathogens in drainage fluid may predict fistula severity and complications.
Purpose of the Study:
- To evaluate high-risk pathogens in postoperative drainage fluid following pancreatectomy.
- To assess the correlation between these pathogens and the severity of postoperative pancreatic fistulas and complications.
Main Methods:
- Retrospective analysis of 429 patients undergoing pancreaticoduodenectomy or distal pancreatectomy (2012-2019).
- Assessment of clinical data and microbiological drainage fluid cultures.
- Univariate and multivariate analyses to identify risk factors for pancreatic fistulas and Clavien-Dindo status.
Main Results:
- Pancreaticoduodenectomy patients had higher rates of severe pancreatic fistulas (grade C) and complications (Clavien-Dindo ≥ III).
- Enterococcus, Enterobacter, and Candida species were the most common pathogens.
- Candida species correlated significantly with grade C fistulas, severe complications (Clavien-Dindo ≥ IV), and pseudoaneurysm hemorrhage.
Conclusions:
- Candida species in drainage fluid post-pancreaticoduodenectomy is a predictor of severe infectious complications, including pancreatic fistulas.
- Regular drainage fluid cultures and monitoring for Candida are recommended to manage severe outcomes.
