An Antimicrobial Stewardship Program in Pancreatic Surgery Reduces the Infectious Risk of Colonized Bile, Reducing the Predictive Value of the Intraoperative Bile Culture: A Before-after Study on 1638 Pancreatoduodenectomies
Authors' conclusion
Pancreatic surgery-specific AMS with tailored SAP reduces SSIs and diminishes the predictive value of colonized bile for SSIs.
Study context
- Population
- Patients undergoing pancreatoduodenectomy, 2015–20221,321 with bile sampling
- Participants
- 1,638 patients
- Exposure
- Post-AMS vs pre-AMS
- Outcome
- Surgical site infections (SSIs), focusing on bile microbiology and colonization
Methodological detailssingle high-volume pancreatic centre
- Single high-volume pancreatic centre
Main finding
As reported in the abstract
SSI, colonized vs non-colonized bile
- Before antimicrobial stewardship (AMS), colonized bile associated with higher SSI rates (38% vs 31%)
- P = 0.008
- Post-AMS, no significant difference (29% vs 28%)
- P = 0.5
- Tailored surgical antibiotic prophylaxis (SAP) reduced overall SSI (34% reduction)
- P = 0.002
- Tailored SAP reduced superficial SSI (59% reduction)
- P = 0.011
Observational data: associations, not effects.
Further findings
Overall SSI with tailored SAP
- Reduction in overall SSI
- 34% reduction, P = 0.002
Superficial SSI with tailored SAP
- Reduction in superficial SSI
- 59% reduction, P = 0.011
Bile colonization
- Samples positive for colonization
- 909 samples (68.8%)
- Enterobacterales
- 75%
- ESBL-producing Enterobacterales
- 18%
- Enterococci
- 60%
- Vancomycin-resistant Enterococci
- 4%
- Colonized bile associated with male sex, jaundice, biliary stenting, positive rectal screening
- P < 0.05
Original publication
An Antimicrobial Stewardship Program in Pancreatic Surgery Reduces the Infectious Risk of Colonized Bile, Reducing the Predictive Value of the Intraoperative Bile Culture: A Before-after Study on 1638 Pancreatoduodenectomies. Ann Surg. Published 1 August 2025. doi:10.
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