Effect of Broad-Spectrum Antibiotic Prophylaxis on Post-Pancreatoduodenectomy Infectious Complications: Nationwide...

Despite improvements in surgical techniques and perioperative management, the incidence of postoperative surgical site infection after pancreatoduodenectomy remains high. This study aim to assess whether broad-spectrum antibiotic prophylaxis can reduce complications after pancreatoduodenectomy compared with standard care antibiotics.

Data of patients who underwent pancreatoduodenectomy between July 2010 and March 2022 were extracted from a nationwide Japanese inpatient database. First- and second-generation cephalosporins were designated as narrow-spectrum, and third- and fourth-generation cephalosporins and piperacillin-tazobactam as broad-spectrum antibiotics. Patients who received either narrow- or broad-spectrum antibiotics on the day of surgery were included in the analysis. Using propensity-score stabilized inverse probability of treatment weighting, the postoperative complications were compared between patients who received antimicrobial prophylaxis with narrow-spectrum antibiotics versus broad-spectrum antibiotics.

From among 45 099 eligible patients, 36 742 (81.5%) and 8357 (18.5%) patients received narrow- and broad-spectrum antibiotics, respectively. After stabilized inverse probability of treatment weighting, the use of broad-spectrum antibiotics bore a significant association with the reduction in intra-abdominal infections [risk difference (RD), -7.4; 95% confidence interval (CI), -8.7 to -6.0], postoperative pancreatic fistula (RD, -3.0; 95% CI, -4.0 to -1.9), post-pancreatectomy hemorrhage (RD, -1.5; 95% CI, -1.9 to -1.1). The use of broad-spectrum antibiotics was also associated with a shorter postoperative length of hospital stay and lower total hospitalization costs. The proportion of Clostridioides difficile infection did not differ between the groups.

The administration of broad-spectrum antibiotics as antimicrobial prophylaxis was associated with better in-hospital postoperative outcomes compared with narrow-spectrum in patients undergoing pancreatoduodenectomy.