Different Biliary Microbial Flora Influence Type of Complications after Pancreaticoduodenectomy: A Single Center Retrospective Analysis.

Background: Bacterobilia is associated with postoperative morbidity after pancreaticoduodenectomy (PD), mostly due to infectious complications. The aim of this study was to investigate the prevalence of bacteria species isolated from intraoperative biliary cultures, and related complications after PD.

Methods: An ANOVA test was used to assess the prevalence of isolated bacterial species and postoperative complications. The odds ratio was computed to evaluate the association between biliary cultures and each complication, Endoscopic Retrograde CholangioPancreatography (ERCP) and each complication, ERCP and biliary cultures, Delayed Gastric Emptying (DGE) and Postoperative Pancreatic Fistula (POPF).

Results: Positive biliary cultures were found in 162/244 (66%) PDs. Different prevalences of polymicrobial biliary culture were detected in patients with postoperative complications. In SSIs, a significant prevalence of biliary culture positive for , and ( < 0.001) was detected. Prevalences of polymicrobial biliary cultures with , , and were significantly associated with POPF ( < 0.001). Biliary culture positive for , and showed a higher prevalence of intra-abdominal collection and DGE ( < 0.001). Notably, was significantly associated with DGE as a unique complication (OR = 2.94 (1.30-6.70); < 0.01).

Conclusions: Specific prevalences of polymicrobial bacterobilia are associated with major complications, while monomicrobial bacterobilia is associated with DGE as a unique complication after PD.