Introduction: Bacterial contamination in the ascitic fluid after pancreaticoduodenectomy (PD) may be an initiating event that leads to clinically relevant postoperative pancreatic fistula (CR-POPF). The aim of this study was to analyze the relationship between CR-POPF after PD and bacteria isolated from the drain fluid and also to investigate the bacterial species in the contaminated ascitic fluid and evaluate useful antibiotics for CR-POPF. Method: A prospectively collected database comprising 267 consecutive patients who underwent PD between May 2012 and December 2018 was analyzed. Amylase and microbial culture were routinely obtained from the peripancreatic drain fluid on postoperative day (POD) 1, 3, and 6. CR-POPF was defined as grade B/C by the international definition. Result: CR-POPF occurred in 81 (30.3%) patients. A significant association with CR-POPF was found for male (P=0.008), Non-pancreatic disease (P<0.001), body mass index (BMI) >25 kg/m2 (P=0.006), preoperative obstructive jaundice (P=0.016), preoperative biliary drainage (P=0.044), narrow pancreatic duct <3 mm (P=0.008), soft pancreas (P<0.001) and bacterial contamination in the drain fluid on POD1 (P<0.001). Multivariate analysis showed that male (Odds ratio [OR]=2.11; P=0.022), BMI (OR=2.24; P=0.027), soft pancreas (OR=3.94; P=0.001), and bacterial contamination in the drain fluid on POD1 (OR=4.70; P<0.001) were independent risk factors of CR-POPF. Bacterial contamination in the drain fluid on POD1, 3, and 6 were seen in 34 (12.7%), 66 (24.7%), and 126 (47.2%) of all patients. The most commonly isolated bacteria on POD1 were Enterococcus sp. (8.6%), Pseudomonas aeruginosa (1.5%), and Enterobacter sp. (1.5%) which were sensitive to piperacillin, imipenem, meropenem, and levofloxacin. In contrast, on POD6, Staphylococcus sp. (19.9%) and Candida sp. (14.2%) were commonly isolated. Conclusion: Early bacterial contamination of the ascitic fluid can be responsible for CR-POPF. To perform the early administration of more sensitive antibiotics for the patients with high risk of postoperative infection is important.
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