Comparing cefazolin/ metronidazole,  piperacillin‐tazobactam, or c efoxitin as surgical antibiotic prophylaxis in patients undergoing pancreaticoduodenectomy: A retrospective cohort study

• Published in: Journal of surgical oncology 2024-06, Vol.129 (8), p.1413-1419
• Main Authors: Park, Lily J., D'Souza, Daniel, Kazi, Tania, Rodriguez, Felipe, Griffiths, Christopher, McKechnie, Tyler, Mertz, Dominik, Serrano, Pablo E.
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; antibacterial agents; antibiotic prophylaxis; Antibiotic Prophylaxis - methods; Cefazolin - administration & dosage; Cefazolin - therapeutic use; Cefoxitin - administration & dosage; Cefoxitin - therapeutic use; Female; Follow-Up Studies; Humans; Male; Metronidazole - administration & dosage; Metronidazole - therapeutic use; Middle Aged; Pancreatic Neoplasms - surgery; pancreaticoduodenectomy; Pancreaticoduodenectomy - adverse effects; Piperacillin, Tazobactam Drug Combination - administration & dosage; Piperacillin, Tazobactam Drug Combination - therapeutic use; Prognosis; Retrospective Studies; surgical wound infection; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control
• ISSN: 0022-4790; 1096-9098; 1096-9098
• DOI: 10.1002/jso.27641

Background Preoperative antibiotic options for pancreaticoduodenectomy (PD) include cefoxitin (CX), piperacillin‐tazobactam (PT), or combined cefazolin and metronidazole (CM). Recent studies suggest the superiority of PT over CX, but evidence for CM is unclear. Objective To explore the impact of preoperative antibiotic selection (CM vs. PT and CX vs. PT) on the development of surgical site infections (SSI). Methods Consecutive adult patients at one institution who underwent PD from November 2017 to December 2021 and received either CM, PT, or CX preoperatively, were included. The primary outcome was SSI. Secondary outcomes included postoperative infections and clinically significant postoperative pancreatic fistula (POPF). Logistic regression models were used. Results Among 127 patients included in the study, PT, CM, and CX were administered in 46 (36.2%), 44 (34.6%), and 37 (29.4%) patients, respectively. There were 32 (27.1%) SSI, 20 (36.1%) infections, and 21 (22.9%) POPF events. PT use was associated with reduced risk of SSI compared to CX (OR: 0.32, 95% CI: 0.11−0.89, p = 0.03), but there was no difference as compared to CM (OR: 0.75, 95% CI: 0.27−2.13, p = 0.59). There were no differences in secondary outcomes. Conclusion PT reduced SSI rates compared to CX but was no different to CM among patients undergoing PD at our center.