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Published on: February 1, 2020
Bacterial shift and resistance pattern in pancreatic head resections after selective decontamination of the digestive
Nicolas Mibelli1, Florian Oehme1, Olga Radulova-Mauersberger1
1Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases, Dresden, Germany: German Cancer Research Center, Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; and Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.
Background:
Pancreatic head resection is associated with postoperative morbidity, primarily because of infectious complications. The microbiota in these infections is crucial, and selective decontamination of the digestive tract (SDD) aims to mitigate this risk by targeting pathogenic organisms while preserving beneficial flora. This study aimed to determine the effect of SDD on bacterial shifts and resistance patterns in pancreatic head resection.
Methods:
All patients who underwent pancreatic head resection either between January 2012 and August 2018 (non-SDD group) or between January 2019 and December 2021 (SDD group) were included. Propensity score-matched analysis was performed to compare the bacterial presence and resistance patterns in bile duct smear tests and postoperative complications.
Results:
Positive bile duct smear tests were observed more often in the non-SDD group (63.5%) than in the SDD group (51.0%). Moreover, the SDD group exhibited a significant reduction in the median number of bacterial species in the bile ducts compared with the non-SDD group (P = .04). However, a notable increase in gram-negative species was observed in the SDD group. The SDD group experienced higher rates of postoperative complications, including relevant pancreatic fistulas (24.8% in the SDD group vs 11.6% in the non-SDD group; P < .01) and delayed gastric emptying (33.8% in the SDD group vs 21.9% in the non-SDD group; P < .01). No significant difference in antibiotic resistance patterns was observed.
Conclusion:
SDD in pancreatic head resection reduces bacterial load in the biliary tract, but it is associated with a shift toward more gram-negative species and higher rates of severe postoperative complications. Our findings suggest that SDD may negatively affect postoperative outcomes and should be carefully considered in clinical practice.
Insights
Selective decontamination of the digestive tract (SDD) reduces biliary tract bacteria in pancreatic surgery but increases gram-negative species and severe complications. Careful consideration of SDD is advised due to potential negative postoperative outcomes.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Infectious Diseases
Background:
- Pancreatic head resection carries significant risk of infectious complications, impacting patient morbidity.
- Selective decontamination of the digestive tract (SDD) is a strategy to reduce pathogenic bacteria while preserving beneficial flora.
- Understanding SDD's impact on microbiota and resistance is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To evaluate the effect of SDD on bacterial shifts in the biliary tract.
- To assess changes in bacterial resistance patterns following SDD.
- To determine the association between SDD and postoperative complications in pancreatic head resection.
Main Methods:
- A propensity score-matched analysis compared patients undergoing pancreatic head resection with and without SDD.
- Bile duct smear tests were analyzed for bacterial presence and species diversity.
- Postoperative complications, including pancreatic fistulas and delayed gastric emptying, were compared between groups.
Main Results:
- SDD was associated with a reduction in bacterial species in bile duct smears (P = .04).
- A significant increase in gram-negative bacterial species was observed in the SDD group.
- The SDD group experienced higher rates of pancreatic fistulas (24.8% vs 11.6%) and delayed gastric emptying (33.8% vs 21.9%).
Conclusions:
- SDD effectively reduces bacterial load in the biliary tract during pancreatic head resection.
- However, SDD leads to a shift towards gram-negative bacteria and increases severe postoperative complications.
- Clinical implementation of SDD in this context requires careful consideration due to adverse outcomes.
