• Annals of surgery · Apr 2024

    Prophylactic Antibiotic Duration and Infectious Complications in Pancreatoduodenectomy Patients with Biliary Stents: Opportunity for De-Escalation.

    • Artem Boyev, Elsa M Arvide, Timothy E Newhook, Laura R Prakash, Morgan L Bruno, Whitney L Dewhurst, Michael P Kim, Jessica E Maxwell, Naruhiko Ikoma, Rebecca A Snyder, Jeffrey E Lee, KatzMatthew H GMHG, and TzengChing-Wei DCD.
    • Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
    • Ann. Surg. 2024 Apr 1; 279 (4): 657664657-664.

    ObjectiveThe 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.BackgroundPre-existing biliary stents have historically been associated with higher infection risk after PD. Patients are administered prophylactic antibiotics, but the optimal duration remains unknown.MethodsThis 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.ResultsAmong 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.ConclusionsAmong 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.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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