{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T08:03:23Z","timestamp":1779696203378,"version":"3.53.1"},"reference-count":43,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Metabolic and bariatric surgery is an established therapeutic option for severe obesity and obesity-related medical problems. Although minimally invasive techniques and enhanced recovery pathways have reduced postoperative morbidity, infectious complications remain clinically relevant because they may lead to readmission, reoperation, prolonged antimicrobial therapy, and mortality. Methods: We conducted a narrative review of the literature on infectious complications after metabolic and bariatric surgery. Evidence was synthesized across five clinically relevant domains: host-related pathophysiology, microbial epidemiology, preoperative optimization, antimicrobial prophylaxis and pharmacokinetic considerations, and diagnosis and management of postoperative infectious complications. Results: Patients with obesity present specific infection-related vulnerabilities, including chronic low-grade inflammation, altered immune responses, impaired tissue oxygenation, obesity-related medical problems, and procedure-specific risks. Contemporary prevention relies on multidisciplinary preoperative optimization, appropriate skin antisepsis, weight-based antimicrobial prophylaxis, intraoperative redosing when indicated, and adherence to enhanced recovery principles. Anastomotic leaks and intra-abdominal abscesses represent the most severe organ\/space infections and require early recognition, source control, antimicrobial therapy, nutritional support, and coordinated surgical, radiological, and endoscopic management. Conclusions: Infectious complications after metabolic and bariatric surgery result from the interaction between host physiology, microbial factors, pharmacological considerations, and surgical technique. A structured approach integrating prevention, early diagnosis, and multidisciplinary management may improve outcomes. Further bariatric-specific studies are needed to strengthen the evidence base for several preventive and therapeutic strategies.<\/jats:p>","DOI":"10.3390\/life16050862","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T06:42:18Z","timestamp":1779691338000},"page":"862","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Infectious Complications in Metabolic and Bariatric Surgery: A Comprehensive Narrative Review of Pathophysiology, Prevention, and Management"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4398-1262","authenticated-orcid":false,"given":"Marcello","family":"Agosta","sequence":"first","affiliation":[{"name":"Department of General Surgery, Cannizzaro Hospital, via Messina 829, 95126 Catania, Italy"},{"name":"Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9899-4040","authenticated-orcid":false,"given":"Egle","family":"Augello","sequence":"additional","affiliation":[{"name":"Postgraduate Residency Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2646-7808","authenticated-orcid":false,"given":"Carlo Maria","family":"Bellanca","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy"},{"name":"Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, 09124 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5650-6911","authenticated-orcid":false,"given":"Andrea","family":"Marino","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana","family":"Rossitto","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cannizzaro Hospital, via Messina 829, 95126 Catania, Italy"},{"name":"Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8113-8452","authenticated-orcid":false,"given":"Giuseppe","family":"Nunnari","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5680-9939","authenticated-orcid":false,"given":"Maria","family":"Sofia","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cannizzaro Hospital, via Messina 829, 95126 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2759-4430","authenticated-orcid":false,"given":"Saverio","family":"Latteri","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cannizzaro Hospital, via Messina 829, 95126 Catania, Italy"},{"name":"Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Sofia, M., Agosta, M., D\u2019Amato, S., Conti, G.N., Mazzone, C., Faletra, G., La Greca, G., and Latteri, S. (2024). Postoperative Biochemical Outcomes in Metabolic Bariatric Surgery: Results from a High-Adherence Cohort. J. Pers. Med., 15.","DOI":"10.3390\/jpm15010007"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1089\/sur.2020.426","article-title":"Surgical Site Infections after Laparoscopic Bariatric Surgery: Is Routine Antibiotic Prophylaxis Required?","volume":"22","author":"Aktas","year":"2021","journal-title":"Surg. Infect."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1308\/003588409X392072","article-title":"Complications of Bariatric Surgery: Presentation and Emergency Management\u2014A Review","volume":"91","author":"Monkhouse","year":"2009","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_4","unstructured":"(2026, May 19). The Impact of Laparoscopy on Infectious Complications After Bariatric Surgery\u2014SAGES Abstract Archives. SAGES, 2019. Available online: https:\/\/www.sages.org\/meetings\/annual-meeting\/abstracts-archive\/the-impact-of-laparoscopy-on-infectious-complications-after-bariatric-surgery\/."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.soard.2011.04.227","article-title":"Predictors of Pulmonary Complications after Bariatric Surgery","volume":"8","author":"Gupta","year":"2012","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1016\/j.soard.2022.06.015","article-title":"Postoperative Pneumonia after Bariatric Surgery during the COVID-19 Pandemic: A National Surgical Quality Improvement Program Study","volume":"18","author":"Grosser","year":"2022","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_7","first-page":"e3798","article-title":"Risk Factors for the Development of Surgical Site Infection in Bariatric Surgery: An Integrative Review of Literature","volume":"31","author":"Silva","year":"2023","journal-title":"Rev. Lat.-Am. Enferm."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1586\/erp.10.26","article-title":"Preventing Surgical Site Infections after Bariatric Surgery: Value of Perioperative Antibiotic Regimens","volume":"10","author":"Chopra","year":"2010","journal-title":"Expert Rev. Pharmacoecon. Outcomes Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1111\/wrr.13223","article-title":"Skin Metabolism in Obesity: A Narrative Review","volume":"32","author":"Zaccaron","year":"2024","journal-title":"Wound Repair Regen."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1038\/s41577-019-0198-4","article-title":"The Intestinal Microbiota Fuelling Metabolic Inflammation","volume":"20","author":"Tilg","year":"2020","journal-title":"Nat. Rev. Immunol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.2337\/db07-1403","article-title":"Changes in Gut Microbiota Control Metabolic Endotoxemia-Induced Inflammation in High-Fat Diet-Induced Obesity and Diabetes in Mice","volume":"57","author":"Cani","year":"2008","journal-title":"Diabetes"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Ichim, C., Boicean, A., Todor, S.B., Anderco, P., and B\u00eerlu\u021biu, V. (2025). Fecal Microbiota Transplantation in Patients with Alcohol-Associated Cirrhosis: A Clinical Trial. J. Clin. Med., 14.","DOI":"10.3390\/jcm14175981"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e89","DOI":"10.1038\/ctg.2015.20","article-title":"Influence of Proton-Pump Inhibitors on the Luminal Microbiota in the Gastrointestinal Tract","volume":"6","author":"Tsuda","year":"2015","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee for Diabetes* (2025). 16. Diabetes Care in the Hospital: Standards of Care in Diabetes\u20142026. Diabetes Care, 49, S339\u2013S355.","DOI":"10.2337\/dc26-S016"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/s11695-021-05741-y","article-title":"Influence of Pre-Operative HbA1c on Bariatric Surgery Outcomes-the Sunderland (UK) Experience","volume":"32","author":"Samuel","year":"2022","journal-title":"Obes. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4171","DOI":"10.1007\/s00464-024-11016-1","article-title":"Low-Calorie Diets Are Effective for Weight Loss in Patients Undergoing Benign Upper Gastrointestinal Surgery: A Systematic Review and Meta-Analysis","volume":"38","author":"Chowdhury","year":"2024","journal-title":"Surg. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e13876","DOI":"10.1111\/obr.13876","article-title":"Low-Energy Diets before Metabolic Bariatric Surgery: A Systematic Review of the Effect on Total Body Weight, Liver Volume, Glycemia and Side Effects","volume":"26","author":"Nilsen","year":"2025","journal-title":"Obes. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bellanca, C.M., Augello, E., Di Benedetto, G., Burgaletto, C., Cantone, A.F., Cantarella, G., Bernardini, R., Polosa, R., and The DiaSmokeFree Working Group (2024). A Web-Based Scoping Review Assessing the Influence of Smoking and Smoking Cessation on Antidiabetic Drug Meabolism: Implications for Medication Efficacy. Front. Pharmacol., 15.","DOI":"10.3389\/fphar.2024.1406860"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7171","DOI":"10.1007\/s00464-022-09498-y","article-title":"Enhanced Recovery after Bariatric Surgery: An Italian Consensus Statement","volume":"36","author":"Marinari","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"UEG\/ESCP\/EAES\/SSI-E SSI Prevention Working Group (2025). European Guideline on Pre-Operative Prevention of Surgical Site Infections Following Digestive Surgery: A Joint Update of the WHO SSI Guideline for Gastrointestinal Surgery by UEG, ESCP, EAES, and SIS-E. United Eur. Gastroenterol. J., 13, 1887\u20131904.","DOI":"10.1002\/ueg2.70128"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1001\/jama.2024.8531","article-title":"Povidone Iodine vs Chlorhexidine Gluconate in Alcohol for Preoperative Skin Antisepsis: A Randomized Clinical Trial","volume":"332","author":"Widmer","year":"2024","journal-title":"JAMA"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"116318","DOI":"10.1016\/j.amjsurg.2025.116318","article-title":"A Comparative Meta-Analysis of Povidone\u2013Iodine\u2013Alcohol vs. Chlorhexidine\u2013Alcohol for Preoperative Skin Antisepsis in Abdominal Surgery","volume":"244","author":"Hsieh","year":"2025","journal-title":"Am. J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Yang, S., Li, Z., Wu, F., Sun, L., He, Y., and Wang, C. (2025). Chlorhexidine versus Povidone-Iodine for Surgical Site Infection Prevention: An Updated Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1641815"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e0171923","DOI":"10.1128\/aac.01719-23","article-title":"Updated Antimicrobial Dosing Recommendations for Obese Patients","volume":"68","author":"Mejuto","year":"2024","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"115281","DOI":"10.1016\/j.biopha.2023.115281","article-title":"Pharmacokinetics of Obese Adults: Not Only an Increase in Weight","volume":"166","author":"Gouju","year":"2023","journal-title":"Biomed. Pharmacother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e504","DOI":"10.1016\/S1473-3099(25)00155-0","article-title":"The Pharmacokinetics of Antibiotics in Patients with Obesity: A Systematic Review and Consensus Guidelines for Dose Adjustments","volume":"25","author":"Barber","year":"2025","journal-title":"Lancet Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.bja.2024.11.044","article-title":"Evaluation of the Need for Dosing Adaptations in Obese Patients for Surgical Antibiotic Prophylaxis: A Model-Based Analysis of Cefazolin Pharmacokinetics","volume":"134","author":"Bindellini","year":"2025","journal-title":"Br. J. Anaesth."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ryan, R., Bosnak, C., Bright, M., Cheng, V., Velli, G., van Zundert, A., Lipman, J., and Roberts, J.A. (2025). Peri-Operative Dosage and Therapeutic Concentrations of Cefazolin Administered for Surgical Site Infection Prophylaxis in Elective Surgery\u2014A Systematic Review. Antibiotics, 14.","DOI":"10.3390\/antibiotics14121227"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1017\/ice.2023.67","article-title":"Strategies to Prevent Surgical Site Infections in Acute-Care Hospitals: 2022 Update","volume":"44","author":"Calderwood","year":"2023","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/s00268-021-06394-9","article-title":"Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update","volume":"46","author":"Stenberg","year":"2022","journal-title":"World J. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"7090128","DOI":"10.1155\/2016\/7090128","article-title":"Simple, Safe, and Cost-Effective Technique for Resected Stomach Extraction in Laparoscopic Sleeve Gastrectomy","volume":"2016","author":"Derici","year":"2016","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e2624","DOI":"10.1002\/rcs.2624","article-title":"Robotic 8-mm Trocar Fascial Wounds: To Close or Not to Close?","volume":"20","author":"Milone","year":"2024","journal-title":"Int. J. Med. Robot. Comput. Assist. Surg."},{"key":"ref_33","unstructured":"Zabaglo, M., Leslie, S.W., and Sharman, T. (2026). Postoperative Wound Infections. StatPearls, StatPearls Publishing."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Fanizza, J., Lavalle, S., Masiello, E., Mandarino, F.V., Altieri, G., Bruni, A., Azzolini, F., Olmi, S., Cesana, G.C., and Anselmino, M. (2026). Endoscopic Management of Post-Bariatric Surgery Complications: Diagnostic Work-Up and Innovative Approaches for Leak, Fistula, and Stricture Management. Diagnostics, 16.","DOI":"10.3390\/diagnostics16030431"},{"key":"ref_35","unstructured":"Chamarthi, V.S., and Daley, S.F. (2026). Perioperative Care for Metabolic and Bariatric Surgery. StatPearls, StatPearls Publishing."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1001\/archsurg.142.10.930","article-title":"Routine Postoperative Upper Gastrointestinal Series After Roux-En-Y Gastric Bypass: Determination of whether it is necessary","volume":"142","author":"Kolakowski","year":"2007","journal-title":"Arch. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"20180031","DOI":"10.1259\/bjr.20180031","article-title":"Imaging Following Bariatric Surgery: Roux-En-Y Gastric Bypass, Laparoscopic Adjustable Gastric Banding and Sleeve Gastrectomy","volume":"91","author":"Clayton","year":"2018","journal-title":"Br. J. Radiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1097\/JS9.0000000000000346","article-title":"Management of Leaks Following One-Anastomosis Gastric Bypass: An Updated Systematic Review and Meta-Analysis of 44 318 Patients","volume":"109","author":"Kermansaravi","year":"2023","journal-title":"Int. J. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1016\/j.cgh.2021.03.020","article-title":"AGA Clinical Practice Update on Evaluation and Management of Early Complications After Bariatric\/Metabolic Surgery: Expert Review","volume":"19","author":"Kumbhari","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"111453","DOI":"10.1016\/j.ijscr.2025.111453","article-title":"Negative Pressure, Positive Outcomes: A Case Report of Endovac Therapy in Complex Sleeve Gastrectomy Leaks","volume":"132","author":"Agosta","year":"2025","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"5496","DOI":"10.1007\/s11695-025-08294-6","article-title":"Endoscopic Treatment of Staple-Line Leaks After Sleeve Gastrectomy in Patients with Obesity: Which One Is the Best Option, If Any? A Systematic Review with Meta-Analysis and Meta-Regression","volume":"35","author":"Galloro","year":"2025","journal-title":"Obes. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1089\/sur.2024.137","article-title":"The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update","volume":"25","author":"Huston","year":"2024","journal-title":"Surg. Infect."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"107290","DOI":"10.1016\/j.ijid.2024.107290","article-title":"Preventing Central Line-Associated Bloodstream Infections: A Position Paper of the International Society for Infectious Diseases, 2024 Update","volume":"150","author":"Rosenthal","year":"2025","journal-title":"Int. J. Infect. Dis."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/5\/862\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T07:12:37Z","timestamp":1779693157000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/5\/862"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":43,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["life16050862"],"URL":"https:\/\/doi.org\/10.3390\/life16050862","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]}}}