The role of bile microbiome research for the prevention of infectious complications of surgical intervention in pancreaticoduodenectomy

The OBJECTIVE was to reconsider the strategy of perioperative antibiotic prophylaxis in patients after pancreaticoduodenectomy (PD) against the background of preoperative biliary drainage to reduce the incidence of surgical site infection (SSI).

METHODS AND MATERIALS. The pilot study was conducted on the effect of personalized perioperative antibiotic prophylaxis in PD on the incidence of acute respiratory viral infections in patients with percutaneous preoperative biliary drainage. The control retrospective group received standard perioperative antibiotic prophylaxis. The main prospective group received perioperative antibiotic prophylaxis based on preoperative bile culture from biliary drainagea. The primary control endpoint was the incidence of SSI.

RESULTS. The control and main groups included 46 and 11 patients, respectively. The susceptibility of pathogens during preoperative bile culture to cephalosporins of the 1st-2nd generation was 21.2%. The highest susceptibility rates were to inhibitor-protected β-lactams of a narrow spectrum: amoxicillin/clavulonate, ampicillin/sulbactam – up to 83.4%. There wasn’t statistical difference in SSI rate between groups: 76.1 % (n=35) vs 81.8 % (n=9), while it’s severity by Clavien – Dindo did not exceed 1-2 degrees of severity in most cases (63.0 % vs 54.5 %). The match between the bile microbiome from the biliary drain and the SSI microbiome was 45.5 %. SSI pathogens were represented by extended-spectrum β-lactamase producers, carbapenem-resistant Enterobacterales.

CONCLUSIONS. The bile microbiome, as well as SSIs following PD, are resistant to cephalosporins of the 1st-2nd generation.The bile microbiome from preoperative biliary drainage does not reflect the features of pathogens involved in SSI, the components of which are both bile pathogens and gastrointestinal pathogens with the properties of extended-spectrum β-lactamases. Further refinement of SSI prevention methods in this patient cohort is required, along with the implementation of perioperative therapy for possible subclinical cholangitis.

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