Piperacillin/tazobactam for surgical prophylaxis during pancreatoduodenectomy: meta-analysis
Jayant Kumar1,2, Isabella Reccia3, Adriano Carneiro4
1Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK.
Background:
Pancreatoduodenectomy is associated with an increased incidence of surgical-site infections, often leading to a significant rise in morbidity and mortality. This trend underlines the inadequacy of traditional antibiotic prophylaxis strategies. Hence, the aim of this meta-analysis was to assess the outcomes of antimicrobial prophylaxis, comparing piperacillin/tazobactam with traditional antibiotics.
Methods:
Upon registering in PROSPERO, the international prospective register of systematic reviews (CRD42023479100), a systematic search of various databases was conducted over the interval 2000-2023. This inclusive search encompassed a wide range of study types, including prospective and retrospective cohorts and RCTs. The subsequent data analysis was carried out utilizing RevMan 5.4.
Results:
A total of eight studies involving 2382 patients who underwent pancreatoduodenectomy and received either piperacillin/tazobactam (1196 patients) or traditional antibiotics (1186 patients) as antibiotic prophylaxis during surgery were included in the meta-analysis. Patients in the piperacillin/tazobactam group had significantly reduced incidences of surgical-site infections (OR 0.43 (95% c.i. 0.30 to 0.62); P < 0.00001) and major surgical complications (Clavien-Dindo grade greater than or equal to III) (OR 0.61 (95% c.i. 0.45 to 0.81); P = 0.0008). Subgroup analysis of surgical-site infections highlighted significantly reduced incidences of superficial surgical-site infections (OR 0.34 (95% c.i. 0.14 to 0.84); P = 0.02) and organ/space surgical-site infections (OR 0.47 (95% c.i. 0.28 to 0.78); P = 0.004) in the piperacillin/tazobactam group. Further, the analysis demonstrated significantly lower incidences of clinically relevant postoperative pancreatic fistulas (grades B and C) (OR 0.67 (95% c.i. 0.53 to 0.83); P = 0.0003) and mortality (OR 0.51 (95% c.i. 0.28 to 0.91); P = 0.02) in the piperacillin/tazobactam group.
Conclusion:
Piperacillin/tazobactam as antimicrobial prophylaxis significantly lowers the risk of postoperative surgical-site infections, major surgical complications (complications classified as Clavien-Dindo grade greater than or equal to III), clinically relevant postoperative pancreatic fistulas (grades B and C), and mortality, hence supporting the implementation of piperacillin/tazobactam for surgical prophylaxis in current practice.
Insights
Piperacillin/tazobactam significantly reduces surgical-site infections and complications after pancreatoduodenectomy compared to traditional antibiotics. This finding supports its use for surgical prophylaxis to improve patient outcomes.
Area of Science:
- Surgical Oncology
- Infectious Diseases
- Pharmacology
Background:
- Pancreatoduodenectomy carries a high risk of surgical-site infections (SSIs), increasing patient morbidity and mortality.
- Traditional antibiotic prophylaxis strategies are often insufficient for preventing SSIs in this high-risk procedure.
Purpose of the Study:
- To compare the efficacy of piperacillin/tazobactam versus traditional antibiotics for antimicrobial prophylaxis in patients undergoing pancreatoduodenectomy.
- To assess the impact on surgical-site infections, major surgical complications, pancreatic fistulas, and mortality.
Main Methods:
- A systematic meta-analysis was conducted, searching databases for studies published between 2000 and 2023.
- Included studies comprised prospective/retrospective cohorts and RCTs, with data analyzed using RevMan 5.4.
- The analysis involved 2382 patients, comparing piperacillin/tazobactam (1196 patients) with traditional antibiotics (1186 patients).
Main Results:
- Piperacillin/tazobactam significantly reduced overall SSIs (OR 0.43) and major surgical complications (OR 0.61).
- Subgroup analysis showed decreased superficial SSIs (OR 0.34) and organ/space SSIs (OR 0.47) with piperacillin/tazobactam.
- This group also experienced significantly lower rates of pancreatic fistulas (OR 0.67) and mortality (OR 0.51).
Conclusions:
- Piperacillin/tazobactam is a superior antimicrobial prophylaxis agent for pancreatoduodenectomy.
- It effectively lowers the risk of SSIs, major complications, pancreatic fistulas, and mortality.
- Implementation of piperacillin/tazobactam in surgical prophylaxis is recommended for current practice.
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