Perioperative antimicrobial therapy in preventing infectious complications following pancreatoduodenectomy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Infectious Diseases

Background:

• Pancreatoduodenectomy (PD) carries a significant risk of infectious complications, affecting up to 45% of patients.
• Preoperative invasive endoscopic procedures increase the incidence of both infectious and overall complications following PD.
• Identifying strategies to mitigate these risks in high-risk patients is crucial.

Purpose of the Study:

• To evaluate the efficacy of a perioperative carbapenem (ertapenem) in reducing infectious complications in high-risk patients undergoing PD.
• To compare infectious complication rates between high-risk (preoperative intervention) and low-risk (no preoperative intervention) patient groups.

Main Methods:

• A retrospective analysis of 135 patients undergoing PD for pancreatic and periampullary lesions.
• Patients were stratified into high-risk (with preoperative endoscopic intervention) and low-risk (without preoperative endoscopic intervention) groups.
• All patients received a three-day course of once-daily ertapenem (1 g).

Main Results:

• No statistically significant differences were observed between the high-risk and low-risk groups in overall morbidity (38.7% vs 35.7%), infectious complications (9.7% vs 4.8%), mortality (2.2% vs 2.4%), or mean postoperative hospital stay (9.2 vs 8.9 days).
• The groups were comparable regarding demographic, nutritional, surgical, and histopathological factors.

Conclusions:

• A perioperative three-day course of once-daily ertapenem did not lead to a significant difference in infectious or overall complications between high-risk and low-risk patients undergoing PD.
• The prophylactic use of ertapenem in this regimen did not appear to mitigate the increased risk associated with preoperative endoscopic interventions in PD patients.