皮佩拉西林-塔佐巴克坦与塞福西丁相比作为胰腺切除术的抗菌预防:一项随机临床试验
Michael I D'Angelica1, Ryan J Ellis1,2, Jason B Liu2,3
1Memorial Sloan Kettering Cancer Center, New York, New York.
JAMA
|April 20, 2023
概括
广泛的抗生素piperacillin- tazobactam与标准的cefoxitin相比显著减少了手术部位感染 (SSI) 和胰腺裂. 这支持其用于预防术后并发症.
科学领域:
- 外科瘤学
- 传染性疾病
- 临床药理学
背景情况:
- 尽管术后护理取得了进展,但术后部位感染 (SSI) 仍然是一个重大问题.
- 在这种复杂的程序后,广泛的抗菌预防对缓解SSI的有效性尚未得到充分证实.
研究的目的:
- 与标准抗生素治疗 (cefoxitin) 相比,评估广泛的外科手术期间的抗菌预防,特别是 piperacillin- tazobactam,对术后SSI的发生率的影响.
主要方法:
- 一个实用的,开放的,多中心的,随机的第三期临床试验,涉及接受开放性胰腺切除术的成年人.
- 参与者被随机分配为接受皮佩拉西林- 塔扎巴克坦或塞福西丁用于外科手术期间的抗菌预防.
- 主要结局是30天的SSI发病率,次要结局包括死亡率,胰腺瘤和败血症.
主要成果:
- 由于疗效,该试验提前结束. 与塞福西相比,皮佩拉西林- 塔扎巴克坦显著降低了SSI发生率 (19. 8% vs 32. 8%,P < 0. 001).
- 在皮佩拉西林- 塔扎巴克坦组中观察到术后败血症和临床相关的胰腺抽率较低.
- 两组之间30天死亡率没有显著差异.
结论:
- 用皮佩拉西林- 塔扎巴克坦进行外科手术预防有效地降低了开放性胰腺切除术后的SSI,胰腺以及相关并发症的发生率.
- 这些发现支持在该患者群体中采用皮佩拉西林- 塔扎巴克坦作为抗菌预防治疗的标准.
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