Preoperative and postoperative multidrug-resistant bacteria significantly impair recovery after pancreatic surgery.

• 20.75% of patients tested positive for multidrug-resistant bacteria, linked to higher complications like pancreatic fistula (37.84% vs. 3.92% in MDR-negative).
• Key outcomes such as major complication rates, ICU stay, and overall hospitalization increased for MDR-positive patients (all p < 0.0001).

Consider preoperative decolonization and broad-spectrum antibiotics for at-risk patients to improve surgical outcomes.