Antibiotic Prophylaxis with Piperacillin-Tazobactam Reduces Post-Operative Infectious Complication after Pancreatic...

Area of Science:

• Surgical Oncology
• Infectious Diseases
• Pharmacology

Background:

• Peri-ampullary tumors often necessitate complex pancreatic surgery.
• Post-operative infections, including surgical site infections (SSIs) and pneumonia, are significant complications.
• Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) colonization poses a risk for surgical site infections.

Purpose of the Study:

• To evaluate the effectiveness of piperacillin-tazobactam as antibiotic prophylaxis.
• To compare outcomes between ampicillin-sulbactam and piperacillin-tazobactam prophylaxis.
• To assess the impact of ESBL-PE colonization on post-operative outcomes.

Main Methods:

• A prospective, non-randomized, interventional study from January 2015 to March 2018.
• Patients undergoing pancreatic surgery for peri-ampullary tumors were screened for ESBL-PE.
• Antibiotic prophylaxis was switched from ampicillin-sulbactam (baseline) to piperacillin-tazobactam (intervention).

Main Results:

• The intervention group (piperacillin-tazobactam) showed lower rates of hospital-acquired infection (33% vs. 43%), superficial SSI (2% vs. 11%), and pneumonia (9% vs. 16%) compared to the baseline group.
• Logistic regression indicated a significantly higher odds ratio for superficial SSI (7.7) and pneumonia (1.8) in the baseline group.
• ESBL-PE colonization was associated with a significantly increased mortality rate (8% vs. 3%).

Conclusions:

• Piperacillin-tazobactam prophylaxis is associated with a reduction in post-operative SSIs, particularly superficial SSIs.
• The findings suggest piperacillin-tazobactam may be a more effective prophylactic agent in this patient population.
• Further randomized controlled trials are warranted to confirm these findings and optimize antibiotic prophylaxis strategies.