Impact of Klebsiella Pneumoniae and Ceftazidime Therapy on Diagnosis of Pancreatic Cancer Patients

Abstract

Extensive research points to microbiota as a potential driver of pancreatic ductal adenocarcinoma proliferation. It was postulated that gammaproteobacteria, including Klebsiella pneumoniae, impact pancreatic ductal adenocarcinoma survival, and that ceftazidime therapy would mitigate this impact.
The current study was a retrospective analysis of patients admitted to Al-Amal Hospital in Baghdad undergoing pancreatico-duodenectomy and preoperative treatment for locally advanced or borderline resectable pancreatic cancers.
Pancreatic ductal adenocarcinoma diagnosed between July 2024 and January 2025, with available bile cultures, was included. A total of 77 patients were evaluated. Various associations were examined between tumor features, survival statistics, antibiotic use, and intraoperative bile culture results. Kaplan–Meier and Cox regression analyses were run to determine survival rates.
End result: A 1.9-month decrease in progression-free survival (PFS) per species (95% C.I. -3.3 to -0.5) was associated with an increasing number of pathogen species detected in intraoperative bile cultures (P = 0.00009).
In patients who tested negative for K. pneumoniae, adjuvant treatment with gemcitabine increased PFS (26.2 months vs. 15.3 months; P = 0.039). In contrast, for patients who tested positive, PFS was not improved (19.5 vs. 13.2 months; P = 0.135).
Median overall survival (OS) improved with ceftazidime treatment, regardless of K. pneumoniae status (48.8 vs. 26.2 months; P = 0.006). Patients receiving ceftazidime who tested positive for K. pneumoniae had a median OS of 26.4 months vs. 18.8 months without it (P = 0.028).
The results show that ceftazidime therapy improves survival and that K. pneumoniae may increase chemoresistance to adjuvant gemcitabine.