Extended antibiotic prophylaxis beyond 24 h after pancreatic surgery: prevalence and risk factors

To evaluate the compliance with antibiotic prophylaxis (AP) guidelines after pancreatic surgery, identify predictors of extended AP usage (>24 h), and assess the association between extended AP and surgical site infection (SSI).

A retrospective cohort study was conducted involving 1,073 patients who underwent pancreatic surgery at the First Affiliated Hospital with Nanjing Medical University between January and December 2022. Based on the strict intent-of-use definition in the electronic medical record, patients were categorized into the AP > 24 h group (n = 135) and the Non-AP > 24 h group (n = 938). Univariate and multivariate logistic regression analyses were performed to identify factors associated with AP > 24 h. Additionally, a hierarchical modeling approach was employed to evaluate the independent association between extended AP and the risk of SSI.

Of the 1,073 patients, 12.58% (135/1,073) received AP > 24 h. The cumulative days of postoperative AP ranged from 1 to 24, with a mean of 6.24 ± 4.09 days. While 93.20% of surgeries were performed in specialized pancreatic centers, 6.80% were performed in non-pancreatic centers. Multivariate analysis identified that surgery performed in non-pancreatic centers was an independent predictor associated with AP > 24 h (OR = 2.61, 95%CI = 1.04-6.54; p = 0.041). Crucially, in the fully adjusted model, extending AP beyond 24 h was not associated with a lower risk of SSI (OR = 1.67, 95% CI: 0.997-2.79; p = 0.053).

A substantial gap between guidelines and clinical practice persists, with 12.58% of patients receiving extended AP. Surgery performed in non-pancreatic centers was identified as a significant predictor for non-adherence, with the odds of extended use being 2.61 times that of specialized centers. Given that prolonged AP was not associated with reduced SSI rates, targeted stewardship interventions are urgently needed to standardize protocols, particularly in non-specialized departments, to avoid unnecessary antibiotic exposure.