ANTIMICROBIAL resistance was associated with poorer outcomes following endoscopic ultrasound guided therapy for infected pancreatic fluid collections, according to a multicentre study of 398 patients.
The study investigated whether microbial profiles and antimicrobial resistance were associated with outcomes following endoscopic ultrasound guided drainage. The primary outcome was time to clinical success, defined by radiographic resolution of the collection to less than 30 mm, no requirement for further intervention and clinical improvement.
Secondary outcomes included surgery free survival, the number of interventions and intensive care unit stay.
Among the 398 patients included, the median age was 56.5 years and 70.6% were male. Microbiologically confirmed infection was identified in 232 patients, representing 58.3% of the study population.
Complete resolution was achieved in 89.2% of infected pancreatic fluid collections, compared with 95.2% of sterile collections. Median time to resolution was also longer among infected collections, at 70 days compared with 57 days.
The greatest delays were observed among patients with Enterococcus infections and polymicrobial resistant infections. Resolution took a median of 87 days for Enterococcus infections (p=0.003) and 120 days for polymicrobial resistant infections (p<0.001).
Enterococcus remained an independent predictor of delayed resolution in multivariable Cox regression. This association was also observed in a sensitivity analysis restricted to patients undergoing necrosectomy, with an adjusted hazard ratio of 2.50 (p=0.002).
Vancomycin resistant Enterococcus infection was associated with particularly poor outcomes. The 26 patients with this infection had a median of six interventions, a median intensive care unit stay of 72 days and mortality of 23%.
Overall, the findings linked Enterococcus species and antimicrobial resistance with poorer outcomes after endoscopic ultrasound guided therapy for pancreatic fluid collections.
The study highlighted the potential importance of microbiology informed treatment strategies in this setting. The findings suggest that identifying specific microbial profiles and resistance patterns may be relevant when managing patients undergoing therapy for infected pancreatic fluid collections.
Reference
Razpotnik M et al. Microbial spectrum and antimicrobial resistance are associated with outcomes after endoscopic ultrasound-guided therapy of pancreatic fluid collections. Sci Rep. 2026;16:24152.
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