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Piperacillin-tazobactam versus cefoxitin as perioperative prophylaxis for pancreatoduodenectomy: real world evidence
Diamantis I Tsilimigras1, Selamawit Woldesenbet1, Dimitrios Moris2
1Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Background:
Antimicrobial prophylaxis with piperacillin-tazobactam was recently demonstrated to reduce the incidence of surgical site infections (SSI) and pancreatic fistula following open pancreatoduodenectomy (PD) compared with cefoxitin. Larger scale, real-world data to confirm effectiveness of piperacillin-tazobactam are lacking.
Methods:
Patients undergoing open PD between 2016 and 2024 were identified in the EPIC Cosmos database. Exposure included perioperative administration of piperacillin-tazobactam versus cefoxitin as antimicrobial prophylaxis. Outcomes included development of SSI, pancreatic fistula, sepsis, multidrug-resistant (MDR) infections, and mortality (all 30-day outcomes).
Results:
Among 4039 patients who underwent open PD, 2496 (61.8 %) received perioperative cefoxitin, while 1543 (38.2 %) received piperacillin-tazobactam. Over time, piperacillin-tazobactam replaced cefoxitin as the predominant antimicrobial prophylaxis (p-trend <0.001). Patients who received piperacillin-tazobactam had a higher Charlson comorbidity index, more frequently had a history of diabetes, smoking and more frequently had preoperative biliary stent placed compared with individuals who received cefoxitin (all p < 0.05). Patients receiving piperacillin-tazobactam had a lower incidence of any SSI, superficial SSI, deep incisional/organ space SSI, pancreatic fistula and sepsis compared with cefoxitin (all p < 0.05). No difference was observed in 30-day MDR infections or mortality (p > 0.05).
Conclusions:
The use of prophylactic piperacillin-tazobactam was associated with better perioperative outcomes compared with cefoxitin among patients undergoing open PD.
Insights
Piperacillin-tazobactam prophylaxis significantly reduced surgical site infections and pancreatic fistulas after open pancreatoduodenectomy compared to cefoxitin. This real-world data confirms its effectiveness in improving perioperative outcomes.
Area of Science:
- Surgical oncology
- Infectious disease prevention
- Pharmacology
Background:
- Piperacillin-tazobactam demonstrated reduced surgical site infections (SSI) and pancreatic fistula post-pancreatoduodenectomy (PD) versus cefoxitin.
- Larger real-world data are needed to confirm piperacillin-tazobactam's effectiveness.
Purpose of the Study:
- To evaluate the real-world effectiveness of piperacillin-tazobactam versus cefoxitin for antimicrobial prophylaxis in open pancreatoduodenectomy.
- To compare rates of SSI, pancreatic fistula, sepsis, multidrug-resistant infections, and mortality.
Main Methods:
- Retrospective analysis of 4039 patients undergoing open PD (2016-2024) from the EPIC Cosmos database.
- Comparison of perioperative piperacillin-tazobactam versus cefoxitin prophylaxis.
- Assessment of 30-day outcomes including SSI, pancreatic fistula, sepsis, MDR infections, and mortality.
Main Results:
- Piperacillin-tazobactam use increased over time, replacing cefoxitin.
- Patients receiving piperacillin-tazobactam had higher comorbidity scores but lower rates of SSI, pancreatic fistula, and sepsis.
- No significant difference in 30-day multidrug-resistant infections or mortality was observed.
Conclusions:
- Prophylactic piperacillin-tazobactam is associated with improved perioperative outcomes in open PD compared to cefoxitin.
- Real-world data support the use of piperacillin-tazobactam for SSI and pancreatic fistula prevention in this patient population.
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