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An Antibiotic Stewardship Program in Pancreatic Surgery.

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Area of Science:

  • Infectious Diseases
  • Surgical Outcomes
  • Public Health

Background:

  • Antimicrobial stewardship (AMS) programs are crucial for optimizing antibiotic use and combating antimicrobial resistance.
  • Limited literature exists on the effectiveness of AMS programs specifically within the context of pancreatic surgery.

Purpose of the Study:

  • To evaluate the impact of a comprehensive AMS intervention on surgical site infection (SSI) rates after pancreatic surgery.
  • To assess the association between targeted surgical antibiotic prophylaxis (SAP) and SSI incidence in this patient population.

Main Methods:

  • A multicenter, before-and-after study comparing patients undergoing pancreatectomy before and after the implementation of an AMS program.
  • The intervention involved preoperative rectal screening for multidrug-resistant bacteria and tailored SAP.
  • Propensity score weighting was used to analyze outcomes, including SSI incidence, SAP appropriateness, and other postoperative complications.

Main Results:

  • The AMS intervention led to a significant reduction in overall SSI rates (30.1% vs. 20.6%) and specific types of SSIs (superficial, deep, organ-space).
  • Surgical antibiotic prophylaxis coverage for rectal and biliary isolates improved substantially.
  • The intervention was associated with fewer complications, reduced length of stay, decreased antibiotic consumption, and substantial cost savings (€247,460).

Conclusions:

  • A multifaceted AMS program tailored for pancreatic surgery effectively decreases SSI rates.
  • The intervention enhances the appropriateness of surgical antibiotic prophylaxis and improves overall clinical outcomes.
  • This approach promotes judicious antibiotic use, reduces complications, and offers significant economic benefits.