Metagenomic landscape of peripancreatic necrotic pus in acute pancreatitis: pathogen ecology, resistance gene profiles, and disease-associated microbial patterns.

Objective: To characterize the metagenomic landscape of intra-abdominal pus from surgical ICU patients using metagenomic next-generation sequencing (mNGS), compare pathogen ecology and resistance gene profiles between acute pancreatitis (AP)-associated and non-pancreatitis abdominal infection, and examine the association between pancreatitis-associated microbial features and persistent organ failure status. Methods: A total of 115 patients undergoing abdominal paracentesis and drainage in a surgical ICU were stratified into three groups: the POF group (AP with persistent organ failure, Results: Compared with Non-AP infections, both AP groups showed a convergent microbial profile dominated by ICU-associated pathogens, including Conclusion: AP-associated peripancreatic pus harbored a distinct microbial ecological profile characterized by reduced community diversity, predominance of ICU-associated pathogens, and broad ARG detection profiles. This pattern was associated with AP status but not with POF at sampling. These findings may complement antimicrobial risk assessment and empirical treatment decisions when interpreted alongside culture-based susceptibility testing and clinical factors, but require validation in prospective multicenter studies.