Back to Search
Start Over
Prophylactic Antibiotic Duration and Infectious Complications in Pancreatoduodenectomy Patients With Biliary Stents: Opportunity for De-escalation.
- Source :
-
Annals of surgery [Ann Surg] 2024 Apr 01; Vol. 279 (4), pp. 657-664. Date of Electronic Publication: 2023 Jul 03. - Publication Year :
- 2024
-
Abstract
- Objective: The aim of this study was to compare infectious complications in pancreatoduodenectomy (PD) patients with biliary stents treated with short, medium, or long durations of prophylactic antibiotics.<br />Background: Pre-existing biliary stents have historically been associated with higher infection risk after PD. Patients are administered prophylactic antibiotics, but the optimal duration remains unknown.<br />Methods: This single-institution retrospective cohort study included consecutive PD patients from October 2016 to April 2022. Antibiotics were continued past the operative dose per surgeon discretion. Infection rates were compared by short (≤24 h), medium (>24 but ≤96 h), and long (>96 h) duration antibiotics. Multivariable regression analysis was performed to evaluate associations with a primary composite outcome of wound infection, organ-space infection, sepsis, or cholangitis.<br />Results: Among 542 PD patients, 310 patients (57%) had biliary stents. The composite outcome occurred in 28% (34/122) short, 25% (27/108) medium, and 29% (23/80) long-duration ( P =0.824) antibiotic patients. There were no differences in other infection rates or mortality. On multivariable analysis, antibiotic duration was not associated with infection rate. Only postoperative pancreatic fistula (odds ratio 33.1, P <0.001) and male sex (odds ratio 1.9, P =0.028) were associated with the composite outcome.<br />Conclusions: Among 310 PD patients with biliary stents, long-duration prophylactic antibiotics were associated with similar composite infection rates to short and medium durations but were used almost twice as often in high-risk patients. These findings may represent an opportunity to de-escalate antibiotic coverage and promote risk-stratified antibiotic stewardship in stented patients by aligning antibiotic duration with risk-stratified pancreatectomy clinical pathways.<br />Competing Interests: The authors report no conflicts of interest.<br /> (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Humans
Male
Retrospective Studies
Anti-Bacterial Agents therapeutic use
Postoperative Complications epidemiology
Postoperative Complications prevention & control
Postoperative Complications drug therapy
Antibiotic Prophylaxis
Stents adverse effects
Pancreaticoduodenectomy adverse effects
Biliary Tract
Subjects
Details
- Language :
- English
- ISSN :
- 1528-1140
- Volume :
- 279
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Annals of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 37389897
- Full Text :
- https://doi.org/10.1097/SLA.0000000000005982