The composition of the stent microbiome is associated with morbidity and adverse events during endoscopic drainage therapy of pancreatic necroses and pseudocysts

Fabian Frost; Valeria Khaimov; Volkmar Senz; Stefan Weiss; Bastian Klußmann-Fricke; Malte Rühlemann; Corinna Bang; Andre Franke; Tilman Pickartz; Christoph Budde; Ali A Aghdassi; Stefan Siewert; Frank U Weiss; Niels Grabow; Markus M Lerch; Matthias Sendler

doi:10.3389/fmed.2024.1462122

The composition of the stent microbiome is associated with morbidity and adverse events during endoscopic drainage therapy of pancreatic necroses and pseudocysts

Front Med (Lausanne). 2024 Sep 16:11:1462122. doi: 10.3389/fmed.2024.1462122. eCollection 2024.

Authors

Fabian Frost¹, Valeria Khaimov², Volkmar Senz³, Stefan Weiss^{1

4}, Bastian Klußmann-Fricke², Malte Rühlemann⁵, Corinna Bang⁵, Andre Franke⁵, Tilman Pickartz⁶, Christoph Budde¹, Ali A Aghdassi¹, Stefan Siewert², Frank U Weiss¹, Niels Grabow³, Markus M Lerch^{1

7}, Matthias Sendler¹

Affiliations

¹ Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.
² Institute for Implant Technology and Biomaterials E. V., Rostock, Germany.
³ Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany.
⁴ Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany.
⁵ Institute of Clinical Molecular Biology, Christian Albrechts University of Kiel, Kiel, Germany.
⁶ Department of Internal Medicine IV, Klinikum Südstadt Rostock, Rostock, Germany.
⁷ Ludwig Maximilian University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.

Abstract

Background: Development of pancreatic necroses or pseudocysts are typical complications of pancreatitis and may require endoscopic drainage therapy using metal or plastic stents. Microbial infection of these lesions poses a major challenge. So far, the composition and significance of the microbial colonization on drainage stents are largely unknown although it may impact outcomes during endoscopic drainage therapy.

Methods: A total of 26 stents used for drainage of pancreatic lesions were retrieved and the stent microbiome was determined by 16S rRNA gene sequencing. Additional analysis included comparison of the stent microbiome to the intracavitary necrosis microbiome as well as scanning electron microscopy (SEM) and micro-computed tomography (μCT) imaging of selected metal or plastic stents.

Results: The stent microbiome comprises a large proportion of opportunistic enteric pathogens such as Enterococcus (14.4%) or Escherichia (6.1%) as well as oral bacteria like Streptococcus (13.1%). Increased levels of opportunistic enteric pathogens were associated with a prolonged hospital stay (r = 0.77, p = 3e-06) and the occurrence of adverse events during drainage therapy (p = 0.011). Higher levels of oral bacteria were associated (r = -0.62, p = 8e-04) with shorter durations of inpatient treatment. SEM and μCT investigations revealed complex biofilm networks on the stent surface.

Conclusion: The composition of the stent microbiome is associated with prolonged hospital stays and adverse events during endoscopic drainage therapy, highlighting the need for effective infection control to improve patient outcomes. In addition to systemic antibiotic therapy, antimicrobial stent coatings could be a conceivable option to influence the stent microbiome and possibly enhance control of the necrotic microflora.

Keywords: LAMS; WON; WOPN; acute pancreatitis; bacteria; microbiota; necrosis microbiome; pancreatic necrosis.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the RESPONSE project (BMBF grant numbers 03ZZ0921A, 03ZZ0921B, and 03ZZ0921E, and 03ZZ0931A, 03ZZ0931D, and 03ZZ0931F).