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In this multicenter study, we investigated whether microbiological profiles and antimicrobial resistance are associated with outcomes after endoscopic ultrasound-guided drainage. The primary endpoint was time to clinical success, defined as radiographic resolution of the PFC to &lt;\u200930\u00a0mm, no need for additional intervention, and clinical improvement. Secondary outcomes included surgery-free survival, number of interventions, and ICU stay. Among 398 included patients (median age: 56.5 years; 70.6% male), 232 (58.3%) had microbiologically confirmed infection. Complete resolution was achieved in 89.2% of infected PFCs\u00a0(median: 70 days; IQR 37\u2013118) versus 95.2% of sterile PFCs (57 days; IQR 33\u201391). Resolution was significantly delayed in\n                    <jats:italic>Enterococcus<\/jats:italic>\n                    (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009107; 26.9%) and polymicrobial resistant infections (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200938; 9.5%): 87 days (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.003) and 120 days (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), respectively.\n                    <jats:italic>Enterococcus<\/jats:italic>\n                    species remained an independent predictor in multivariable Cox regression, and in a sensitivity analysis restricted to the necrosectomy group (aHR 2.50;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002). Vancomycin-resistant\n                    <jats:italic>Enterococcus<\/jats:italic>\n                    (VRE) infection (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200926; 6.5%) was associated with the highest number of interventions (median: 6), longest ICU stays (median: 72 days), and highest mortality (23%). In summary, this study identifies an association of\n                    <jats:italic>Enterococcus<\/jats:italic>\n                    species and antimicrobial resistance with poor outcomes after EUS-guided therapy, emphasizing the importance of microbiology-informed treatment strategies.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-64436-5","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T06:17:57Z","timestamp":1785910677000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Microbial spectrum and antimicrobial resistance are associated with outcomes after endoscopic ultrasound-guided therapy of pancreatic fluid collections"],"prefix":"10.1038","volume":"16","author":[{"given":"Marcel","family":"Razpotnik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"J\u00fcrgensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Sigal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toni","family":"Herta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zlem","family":"\u00c7elebi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Adler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silke","family":"Leonhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Branchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliane","family":"Buchkremer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Kouladouros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Wree","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Pilz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus M.","family":"Heimesaat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britta","family":"Siegmund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius","family":"Engelmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Tacke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"issue":"11","key":"64436_CR1","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1038\/s41575-023-00808-w","volume":"20","author":"E de-Madaria","year":"2023","unstructured":"de-Madaria, E. & Buxbaum, J. 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