Multi-Drug-Resistant Bacterial Infection after Pancreatoduodenectomy: Risk Factors and Clinical Impact.

Abstract

Background: Infection by multi-drug-resistant (MDR) bacteria is a high-risk factor for poor clinical results. Pancreatoduodenectomy (PD) has been associated with a high rate of complications, including intra-abdominal infections. However, there are few data available regarding MDR infection in patients undergoing PD. This study evaluated the present situation of risk factors for and clinical impact of MDR infection on patients who received PD. Methods: A total of 357 consecutive patients who underwent PD in our department from January 2016 to June 2018 were analyzed retrospectively. They were grouped into those with MDR infection (observation group) and those without MDR infection (control group). Univariable and multivariable analyses were used to identify risk factors for MDR infection in the two groups and the relations between MDR infection and clinical outcome. Results: Infections by MDR bacteria occurred in 38 patients (10.6%), and a total of 49 MDR bacterial strains were detected. Carbapenem-resistant Acinetobacter baumannii and MDR Pseudomonas aeruginosa were the most common strains. Multivariable analysis suggested that pancreatic fistula (p = 0.001) and post-operative use of quinolones (p = 0.000) were risk factors for MDR infection. At the same time, MDR infection was an independent risk factor for an increase in the 30-day in-hospital mortality rate (p = 0.005). Conclusions: Intensive intra-operative management to reduce the incidence of pancreatic fistula as well as curtailing empirical use of antibiotics, especially quinolones, may help to reduce the incidence of MDR infection and thus in-hospital deaths.