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Third-generation cephalosporin for antimicrobial prophylaxis in pancreatoduodenectomy in patients with internal
Shusei Sano1, Teiichi Sugiura1, Ichiro Kawamura2
1Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan.
Background:
The aim of the present study was to investigate whether the incidence of surgical site infection after pancreatoduodenectomy decreased after changing the prophylactic antibiotic to a third-generation cephalosporin in patients with unknown preoperative bile culture results after biliary drainage.
Methods:
In a retrospective study of 138 pancreatoduodenectomy patients who underwent endoscopic biliary stenting and for whom recent preoperative bile culture results were unavailable, cefazolin sodium hydrate was administered as perioperative prophylactic antibiotic therapy from 2010 to 2014 (n = 69); whereas ceftriaxone was administered from 2014 to 2017 (n = 69) based on the results of institutional culture surveillance. The incidence of surgical site infection was compared between the two groups and the risk factor of surgical site infection was also evaluated.
Results:
The incidence of overall surgical site infection in the ceftriaxone group was significantly lower than that in the cefazolin sodium hydrate group for both Clavien-Dindo grade ≥II (28% versus 52%, P = .005) and Clavien-Dindo grade ≥IIIa (20% vs 41%, P = .016). A multivariate analysis revealed that the prophylactic administration of cefazolin sodium hydrate was associated with a higher incidence of overall surgical site infection in both Clavien-Dindo grade ≥II and Clavien-Dindo grade ≥IIIa (odds ratio 2.56, P = .019; odds ratio 3.03, P = .020, respectively). In the cefazolin sodium hydrate group, most of the patients with positive perioperative cultures had Enterobacteriaceae, which were intrinsically resistant to cefazolin sodium hydrate, and most were susceptible to ceftriaxone.
Conclusion:
The prophylactic administration of third-generation cephalosporin reduced the incidence of surgical site infection after pancreatoduodenectomy in patients who underwent preoperative endoscopic biliary stenting.
Insights
Switching prophylactic antibiotics to third-generation cephalosporin, like ceftriaxone, significantly reduced surgical site infections after pancreatoduodenectomy. This change improved patient outcomes in those with unknown preoperative bile cultures following biliary drainage.
Area of Science:
- Surgical Oncology
- Infectious Diseases
- Gastroenterology
Background:
- Surgical site infection (SSI) is a significant complication after pancreatoduodenectomy.
- Prophylactic antibiotic choice may influence SSI rates, particularly in patients undergoing biliary drainage with unknown preoperative bile cultures.
Purpose of the Study:
- To evaluate the impact of changing perioperative prophylactic antibiotics from cefazolin sodium hydrate to a third-generation cephalosporin (ceftriaxone) on SSI incidence.
- To identify risk factors for SSI in patients undergoing pancreatoduodenectomy with preoperative biliary stenting.
Main Methods:
- Retrospective study of 138 patients undergoing pancreatoduodenectomy with preoperative biliary stenting and unavailable recent bile cultures.
- Comparison of SSI rates between patients receiving cefazolin sodium hydrate (2010-2014) and ceftriaxone (2014-2017).
- Multivariate analysis to assess risk factors for SSI.
Main Results:
- The ceftriaxone group showed significantly lower SSI incidence (Clavien-Dindo grade ≥II: 28% vs 52%; ≥IIIa: 20% vs 41%).
- Cefazolin sodium hydrate use was associated with higher SSI risk (OR 2.56 for ≥II, OR 3.03 for ≥IIIa).
- Enterobacteriaceae, resistant to cefazolin but susceptible to ceftriaxone, were prevalent in positive perioperative cultures.
Conclusions:
- Prophylactic administration of third-generation cephalosporins, specifically ceftriaxone, effectively reduced SSI after pancreatoduodenectomy in patients with preoperative biliary stenting.
- The findings support optimizing prophylactic antibiotic strategies based on institutional antibiograms and pathogen resistance patterns.
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