An Antimicrobial Stewardship Program in Pancreatic Surgery Reduces the Infectious Risk of Colonized Bile, Reducing the Predictive Value of the Intraoperative Bile Culture
Bibliographic record
Abstract
OBJECTIVE: To evaluate the pancreatic surgery-specific antimicrobial stewardship (AMS) program on surgical site infections (SSIs), focusing on bile microbiology and colonization. BACKGROUND: Colonized bile is well known to increase the risk of SSIs after pancreatoduodenectomy. However, AMS programs seem to reduce their occurrence. METHODS: This observational before-after study included patients who underwent pancreatoduodenectomy from 2015 to 2022 at a high-volume pancreatic center (#NCT04199494). Pre-AMS data spanned from January 2015 to November 2019, and post-AMS data from December 2019 to October 2022. Intraoperative bile samples were analyzed for microbiology. The AMS program involved preoperative rectal screening for multidrug-resistant bacteria to guide personalized surgical antibiotic prophylaxis (SAP). Tailored SAP was used for patients colonized with resistant pathogens. SSI rates, length of stay, major and pancreatic surgery-specific complications, and mortality were assessed using standard statistics. RESULTS: Of 1638 patients included, 1321 (80.6%) had intraoperative bile sampling, with 909 samples (68.8%) testing positive for colonization. The most common bacteria were Enterobacterales (75%), 18% extended-spectrum beta-lactamase-producing, and Enterococci (60%), 4% of which were vancomycin-resistant. Colonized bile was associated with male sex, jaundice, biliary stenting, and positive rectal screening ( P < 0.05). Before AMS, colonized bile correlated with higher SSI rates (38% vs 31%, P = 0.008). Post-AMS, no significant difference was observed (29% vs 28%, P = 0.5). Tailored SAP reduced overall SSI (34% reduction, P = 0.002) and superficial SSI (59% reduction, P = 0.011). CONCLUSIONS: Pancreatic surgery-specific AMS with tailored SAP reduces SSIs and diminishes the predictive value of colonized bile for SSIs. Intraoperative bile cultures remain valuable for postoperative management.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".