Background and aims: Enterococcus has emerged as a virulent species; Enterococcus faecium especially has arisen as a source of nosocomial infections. furthermore, specific Enterococcus faecalis species are significantly associated with anastomotic leakage in rodent studies. The objective of this study was to investigate whether the occurrence of Enterococci (E. faecium and E. faecalis) obtained from drain samples was associated with leakage in humans undergoing pancreaticoduodenectomy.

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Major surgery is associated with substantial morbidity and mortality with early post‐operative adverse events (POAE) occurring in 30% of patients within the first 30 days. The underlying pathogenesis is multifactorial, including immune dysfunction and increased inflammatory response to surgery. We investigated preoperative immune function by the TruCulture® whole blood technique in a cohort of patients undergoing pancreaticoduodenectomy (PD), hypothesizing that patients developing inflammatory POAE defined as leucocytosis, fever or high (above median) area under the curve (AUC) C‐reactive protein (CRP) the first post‐operative week would display perturbed preoperative immune function. Sixty‐two adult patients were screened, 30 included and 11 excluded post‐inclusion due to other surgical procedures than PD and post‐operative complications directly attributed to surgery, leaving 19 patients for analysis of preoperative immune function. Patients developing leucocytosis (n = 5, 26%) had lower Toll‐like receptor (TLR)‐3–stimulated IL‐12p40 and higher Candida Albicans (TLR1/2/4/6, Dectin‐1)‐stimulated TNF‐α, compared to patients without leucocytosis (all P < .05). Patients developing fever (n = 7, 37%) had lower TLR7/8‐stimulated IFN‐γ and patients with high AUC CRP (n = 9, 47%) had lower TLR3‐stimulated IFN‐γ and IL‐6 and lower TLR7/8‐stimulated IL‐10 (all P < .05), compared to patients without fever or low CRP, respectively. In conclusion, patients with inflammatory POAE displayed lower preoperative stimulated IL‐12p40, IFN‐γ, IL‐6 and IL‐10 and higher TNF‐α response, compared to patients without inflammatory POAE. This finding suggests that TruCulture is a feasible immunologic screening tool in surgical patients, with a potential for preoperative identification of patients at increased risk for inflammatory POAE, allowing for risk‐based intervention trials.