Neoadjuvant chemotherapy for pancreatic cancer and changes in the biliary microbiome.

Abstract:

BACKGROUND:The use of neoadjuvant chemotherapy (NAC) for pancreatic ductal adenocarcinoma (PDAC) has increased in recent years. Limited data exists on the impact of NAC on biliary microbiome. METHODS:Patients who underwent pancreaticoduodenectomy (PD) for PDAC between 2014 and 2017 were reviewed. Patients were stratified into two groups based on their NAC status for comparison. RESULTS:Of 168 patients included, 63 (37.5%) received NAC. Patients who received NAC exhibited significantly increased growth of Gram-negative anaerobic bacteria (p = 0.043). Patients in the non-NAC group were more likely to grow pathogens resistant to ampicillin-sulbactam (47% vs 21%, p = 0.007), cefazolin (49% vs 28%, p = 0.040), cefoxitin (42% vs 11%, p = 0.009) and cefuroxime (26% vs 4%, p = 0.019). NAC status did not impact infectious postoperative outcomes, including SSIs. CONCLUSION:Patients who did not receive NAC were more likely to grow pathogens resistant to cephalosporins. Perioperative antibiotic prophylaxis should be tailored to cover Gram-negative organisms and enterococci.

journal_name

Am J Surg

authors

Nadeem SO,Jajja MR,Maxwell DW,Pouch SM,Sarmiento JM

doi

10.1016/j.amjsurg.2020.09.042

subject

Has Abstract

pub_date

2020-10-05 00:00:00

eissn

0002-9610

issn

1879-1883

pii

S0002-9610(20)30612-7

pub_type

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