Microbiology of pancreatoduodenectomy and recommendations for antimicrobial prophylaxis

Abstract

Background The microbiology of pancreatoduodenectomy is challenging and published guidelines regarding perioperative antimicrobial prophylaxis are variable with poor adherence. Methods A retrospective analysis of the microbiological results of 294 consecutive patients who underwent pancreatoduodenectomy was performed. Intraoperative specimen culture results were available for 50 patients and their medical records were reviewed to determine the following demographics and factors; age; sex; tumour location, histopathology, grade and stage; neoadjuvant chemotherapy and radiotherapy; preoperative biliary stenting; surgeon; surgery type and antimicrobial prophylaxis coverage. Outcomes assessed included; post‐operative infections, mortality (all and 90‐day), and intensive care unit and hospital admission durations. Univariate analysis with chi‐squared testing was performed. Results Intraoperative specimen cultures were positive in 48 (96%) patients and polymicrobial in 45 (90%) patients with a predominance of Enterobacteriaceae (38/76%), Enterococcus species (27/54%), and Candida species (25/50%). Isolates were potentially susceptible to the current perioperative antimicrobial prophylaxis regimen of ceftriaxone with or without metronidazole in only six patients. However, only neoadjuvant radiotherapy was associated with statistically significant increased intensive care unit and hospital admission durations. Conclusion Although this study was probably underpowered to detect any statistically significant associations, perioperative antimicrobial prophylaxis coverage of the operative field microbiological milieu of pancreatoduodenectomy is logical and current guidelines may be inadequate.

Oncobiosis and Microbial Metabolite Signaling in Pancreatic Adenocarcinoma

“…The pathogenic role of bacterial invasion in the pancreas was demonstrated by the decreased incidence of pancreatic adenocarcinoma in gnotobiotic or antibiotic-treated mice [65]. Similar issues were raised in conjunction with human premedication before surgery in pancreatic carcinoma patients [92]. There seems to be a specificity among the antibiotics.…”

“…In the oral microbiome, Porphyromonas gingivalis increased in pancreatic adenocarcinoma [64,82,83,85,101]. Helicobacter pylori [62,69,70], Enterobacter, Enterococcus [64,90,92,93], Fusobacteria [89,94,102], and E. coli [64,93] were also shown to increase in pancreatic adenocarcinoma patients in multiple studies. In a study assessing intratumor DNA and serum cell-free DNA (1000+ patients), Fusobacteria count in tumors was higher compared to the healthy, untransformed tissues [102].…”

“…Characteristic changes occur to the oral [63,[81][82][83][84][85][86][87][88] and duodenal microbiome [64] in pancreatic adenocarcinoma. Enterobacter, Enterococcus, and E. coli bactibilia [78] or the colonization of the pancreas [41,65,68,[89][90][91][92][93][94] are risk factors for pancreatic adenocarcinoma. Of note, an oncogenic role of hepatotropic viruses (Hepatitis B and C virus and Transfusion Transmitted/Torque Teno virus) in pancreatic adenocarcinoma has been observed in a clinical setting, although the exact molecular mechanisms are yet unknown [78].…”

“…Classical culture 96% of the specimens demonstrated the presence of microbes, 90% of all cases were polymicrobial. The most frequent species found were Enterobacteriaceae, Enterococcus species, Candida species, and Streptococcus milleri [92] 152 Italian patients of which 72 had pancreas head adenocarcinoma patients were present Classical culture…”

“…As the detection of pancreatic adenocarcinoma is difficult at early (curable) stages, early detection through detecting oncobiotic transformation has clear advantages for patients. The choice of antibiotics used for premedication before surgical excision of pancreatic adenocarcinoma can also be based on the composition of the pancreatic microbiome [92].…”