The impact of colonization with MDRO in complex surgical patients (TIARA)
Major abdominal surgery in particular is associated with high postoperative infection rates. Despite well-established surveillance systems for surgical wound infections, there is a lack of comprehensive reporting on infectious complications and the impact of the use of anti-infectives during and after surgery. The TIARA project aims to close this knowledge gap and to develop a model based on collected biomaterials and clinical data that can predict infectious complications as well as the occurrence of multidrug-resistant pathogens as they develop after intra-abdominal surgery. For cancer patients, the model will also include data on oncological outcome, such as cure rates for colorectal or pancreatic cancer. Furthermore, in the long term, with the help of this model, existing anti-infective interventions should be improved and the peri- and postoperative morbidity and infection rate as well as unnecessary or inadequate treatments with anti-infectives should be reduced. TIARA is led by Prof. Dr Jörg Janne Vehreschild and Prof. Dr Maria J.G.T. Vehreschild.
As part of the multicentre, prospective observational study TIARA (The impact of colonization with MDRO in complex surgical patients), a cohort of 1,200 patients with open or laparoscopic procedures for partial or complete removal of the pancreas/duodenum (pancreaticoduodenectomies), large intestine (colon resections) or end bowel (rectal resections) will be included at eight German university hospitals over five years.
During the observation period of these patients, a comprehensive collection of clinical data and biosamples (e.g. wound and nasal swabs) takes place before, during and after the operation at fixed visit times. Further samples are taken depending on the occurrence of predefined clinical events. The collected biomaterial is analysed for its microbiota using sequence and culture-based approaches. Furthermore, relevant pathogens are subjected to in-depth molecular characterisation. The data will then be entered into a biobank serving as a basis for future docking projects.
With the help of the collected data on biomaterials and clinical course of the patients, the three underlying hypotheses of TIARA will be tested within the framework of an integrated, complex data analysis:
- The extent of antibiotic exposure after intra-abdominal surgery correlates with the occurrence of multidrug-resistant organisms (MDROs).
- The dominance of a particular species within the microbiota precedes infection.
- The disturbance of the microbiome influences the (oncological) outcome after intra-abdominal surgery.
In addition, an interdisciplinary Antimicrobial Stewardship Board will be established to evaluate the anti-infective treatments of all study patients according to a standardised scheme. In addition, the patients' quality of life will be assessed at fixed points in time using standardised questionnaires.
