Background
The aim of the present study was to investigate whether the incidence of surgical
site infection after pancreatoduodenectomy decreased after changing the prophylactic
antibiotic to a third-generation cephalosporin in patients with unknown preoperative
bile culture results after biliary drainage.
Methods
In a retrospective study of 138 pancreatoduodenectomy patients who underwent endoscopic
biliary stenting and for whom recent preoperative bile culture results were unavailable,
cefazolin sodium hydrate was administered as perioperative prophylactic antibiotic
therapy from 2010 to 2014 (n = 69); whereas ceftriaxone was administered from 2014 to 2017 (n = 69) based on the results of institutional culture surveillance. The incidence of
surgical site infection was compared between the two groups and the risk factor of
surgical site infection was also evaluated.
Results
The incidence of overall surgical site infection in the ceftriaxone group was significantly
lower than that in the cefazolin sodium hydrate group for both Clavien-Dindo grade
≥II (28% versus 52%, P = .005) and Clavien-Dindo grade ≥IIIa (20% vs 41%, P = .016). A multivariate analysis revealed that the prophylactic administration of
cefazolin sodium hydrate was associated with a higher incidence of overall surgical
site infection in both Clavien-Dindo grade ≥II and Clavien-Dindo grade ≥IIIa (odds
ratio 2.56, P = .019; odds ratio 3.03, P = .020, respectively). In the cefazolin sodium hydrate group, most of the patients
with positive perioperative cultures had Enterobacteriaceae, which were intrinsically
resistant to cefazolin sodium hydrate, and most were susceptible to ceftriaxone.
Conclusion
The prophylactic administration of third-generation cephalosporin reduced the incidence
of surgical site infection after pancreatoduodenectomy in patients who underwent preoperative
endoscopic biliary stenting.
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Article info
Publication history
Published online: October 26, 2018
Accepted:
September 24,
2018
Received in revised form:
September 22,
2018
Received:
May 23,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
