Colonization with multiresistant organisms (MROs) may lead to shorter overall survival in patients with cholangiocarcinoma (CCA) who undergo surgical resection, according to a recently published study in Liver International.

Although surgical resection is the preferred treatment for CCA, the prognosis after curative intent surgery is grim, with a median survival rate of approximately 30 months after surgery. Nodal resection is currently the main predicting factor for survival after surgery; however, more prognostic markers are required to improve the clinical management of these patients, reported Maximilian N. Kinzler, MD, of the University Hospital Frankfurt in Germany, and colleagues.

Colonization with MROs such as methicillin-resistant Staphylococcus aureus (MRSA) is known to impact survival in hospitalized patients and patients with hematological malignancies. Still, its impact on patients with CCA who undergo curative intent surgery has not been investigated, the study authors.

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“Against this background, the aim of the current study was to investigate prevalence and impact on clinical outcome of MRO colonization in patients with CCA after surgical resection,” the researchers wrote. 

The retrospective study included data from 169 patients that underwent curative intent surgery for CCA and were screened for MROs in nasal, rectal, and pharyngeal regions between 2005 and 2021 at the University Hospital of Frankfurt in Germany.

A third of the included patients were colonized by MROs; notably, over 80% of the colonized patients were men. Other than a higher incidence of diabetes in the colonized group, there was no significant difference in the clinical characteristics of the groups.

The median overall survival of the 169 patients was 26 months. In the noncolonized group, the median overall survival was 50 months, and in the colonized group, the incidence was 17%, which represented a statistically significant difference between both groups. The difference was similar when separating patients according to CCA subtypes. 

Vancomycin-resistant Enterococcus faecium was the most common MRO present in over 50% of colonized patients. 

The authors noted that noncancer-related deaths were more common in the colonized group than in the noncolonized group. As expected, infectious-related death was more common in the colonized group. Multivariate Cox regression analysis determined that MRO colonization was a significant risk factor for shorter overall survival in CAA.

“In the light of rising rates of MDRO colonization, frequent screening is necessary to optimize clinical management of infections and to potentially reduce mortality of patients with CCA,” the authors concluded.


Kinzler M, Stehle A, Schulze F, et al. Colonization with multidrug‐resistant organisms is associated with impaired survival of patients with surgically resected cholangiocarcinoma. Liver Int. Published online November 24, 2022. doi:10.1111/liv.15485