The Relative Role of Bile Bacterial Isolation on Outcome in Stent-Bearing Patients Undergoing Pancreatoduodenectomy

  • Marta Sandini
  • Kim C. Honselmann
  • Marco Cereda
  • Marco Angrisani
  • Francesca Gavazzi
  • Ulrich Wellner
  • Louisa Bolm
  • Tobias Keck
  • Alessandro Zerbi
  • Luca GianottiEmail author
Original Article



Biliary stenting leads to antimicrobial-resistant (AMR) microorganism retrievement in bile cultures. However, the impact of intraoperative bile colonizations on post-pancreaticoduodenectomy complications remains unclear. Aims of our study were to characterize the bile flora of stented patients in comparison with postoperative cultures and to analyze whether patterns of drug resistance affected postoperative outcomes.


We analyzed records from stent-bearing pancreaticoduodenectomy patients at 3 European centers. Intra- and postoperative cultures were compared and classified as multidrug sensitive (MDS), multidrug resistant (MDR), and extensively drug resistant (XDR). Thirty-day complications were graded according to international standards.


Out of 270 patients, intraoperative cultures were positive in 219 (81.1%) cases. In 36.7%, MDS species were isolated; in 35.9%, MDR; and in 8.5%, XDR species. A solid correspondence between the species isolated intra- and postoperatively (p < 0.001) was observed. Intraoperative MDR/XDR isolation was associated with an increased rate of surgical (p = 0.043) and infectious complications (p = 0.030), but not severe complication rate (p = 0.973). Postoperative MDR/XDR isolation was associated with higher risk of major complications (45.6% vs. 15.8%, p < 0.001), postoperative pancreatic fistula (p < 0.001), and post-pancreatectomy hemorrhage (p = 0.002). By multivariate analysis, intraoperative AMR isolation was associated with high likelihood of postoperative AMR infections. However, only in 43/121 cases, intraoperative MDR/XDR microorganisms turned into the occurrence of postoperative infections.


Intraoperative AMR isolates do not translate into severe outcomes, despite being significantly associated with surgical and infectious complications.


Pancreatoduodenectomy Biliary stent Antimicrobial resistance Infectious complications Outcomes 


Authors’ Contribution

MS, KH, MC, MA, LB, FG, UW, TK, AZ, and LG are involved in the preparation of the proposal and study design and participated in data collection, data entry, and data analysis. MS, KH, and LG are involved in manuscript preparation. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Availability of Data and Materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

Not applicable given the retrospective nature of the study design.

Supplementary material

11605_2019_4388_MOESM1_ESM.docx (1.3 mb)
ESM 1 (DOCX 1290 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Marta Sandini
    • 1
  • Kim C. Honselmann
    • 2
  • Marco Cereda
    • 1
    • 3
  • Marco Angrisani
    • 1
  • Francesca Gavazzi
    • 3
  • Ulrich Wellner
    • 2
  • Louisa Bolm
    • 2
  • Tobias Keck
    • 2
  • Alessandro Zerbi
    • 3
  • Luca Gianotti
    • 1
    Email author
  1. 1.School of Medicine and Surgery, Department of Surgery, San Gerardo HospitalMilano Bicocca UniversityMonzaItaly
  2. 2.Department of SurgeryUniversity Medical Center Schleswig-Holstein, Campus LübeckLübeckGermany
  3. 3.Pancreatic Surgery Unit, Department of SurgeryHumanitas Research Hospital and UniversityMilanItaly

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