High incidence of postoperative infections after pancreaticoduodenectomy: A need for perioperative anti-infectious strategies

•Documented or clinically suspected postoperative infections after cephalic pancreaticoduodenectomy occur in more than two thirds of patients and are associated with high antibiotic consumption.•Documented postoperative infections in patients with bile colonization involve a microorganism isolated from the bile in 2/3 of cases and may be associated with a higher rate of severe complications.•The most frequently isolated microorganisms in bile were Gram-negative bacilli (GNB) (57%) with a predominance of Escherichia coli and Klebsiella spp., followed by Gram-positive cocci (GPC) (43%) with a predominance of Enterococci and Streptococci.•Bile colonization and postoperative infections with Enterococcus faecium and Candida spp. remain scarce.•A short-term probabilistic perioperative antibiotic therapy adapted to the bile bacterial ecology rather than a surgical antibiotic prophylaxis may be prescribed to patients undergoing cephalic pancreaticoduodenectomy. This has to be evaluated in prospective, randomized, controlled trials.