Abstract:Objective To investigate the risk factors for pancreatic fistula combined with abdominal infection after pancreaticoduodenectomy, and to analyze the composition of pathogens and their drug sensitivity. Methods A retrospective analysis was conducted on clinical data from 247 patients who underwent pancreaticoduodenectomy at the Second Affiliated Hospital of Kunming Medical University from January 2018 to October 2022. Among them, 73 cases developed pancreatic fistula combined with abdominal infection (case group), and 174 cases did not develop (control group). The risk factors for postoperative pancreatic fistula complicated by abdominal infection and the predominant pathogens and antibiotic susceptibility based on culture results of abdominal drainage fluid were analyzed. Results Logistic regression analysis indicated that diabetes mellitus (OR=2.532, 95%CI: 1.062-6.041), intraoperative blood loss ≥1000 mL (OR=2.454, 95%CI: 1.099-5.894), soft pancreatic texture (OR=2.551, 95%CI: 1.380-4.718), and pancreatic duct diameter ≤3 mm (OR=4.464, 95%CI: 2.352-8.472) were independent risk factors for pancreatic fistula complicated by abdominal infection. Preoperative biliary drainage (OR=0.355, 95%CI: 0.187-0.672) was identified as a protective factor. There were 43 patients with abdominal drainage cultured of 23 types of bacteria, resulting in a cumulative count of 163 strains. There were 88 gram-negative strains (53.99%), which Klebsiella pneumoniae exhibited the lowest susceptibility to ampicillin (0) and the highest susceptibility to imipenem (57.69%). The susceptibility of Escherichia coli to ampicillin and cephalosporin was less than 10%, while its susceptibility to β-lactam was 100%. Acinetobacter baumannii demonstrated a relatively high susceptibility to polymyxin E (28.57%), but its susceptibility to aztreonam was 0. There were 52 strains of Gram-positive bacteria (31.90%), mainly Enterococcus faecium and Enterococcus faecalis, which had the lowest sensitivity to erythromycin and clindamycin at 0, and to tigecycline, vancomycin, and teikoplanin has the highest sensitivity, 100%. There were 23 strains of fungi (14.11%). The main fungus was Candida albicans. It was highly sensitive to fluconazole and voriconazole at 88%, and its sensitivity to amphotericin B was less than 10%. Conclusion Diabetes mellitus, intraoperative blood loss ≥1 000 mL, soft pancreatic texture, and pancreatic duct diameter ≤3mm are independent risk factors for pancreatic fistula complicated with abdominal infection. Preoperative biliary drainage is a protective factor. And antibiotics should be used clinically based on the results of drug susceptibility testing.