Perioperative prophylaxis with piperacillin-tazobactam reduces complications following open pancreatoduodenectomy: JAMA

Though perioperative mortality has improved, the incidence of SSI remains high after pancreatoduodenectomy. More data and research is required for the effect of broad-spectrum antimicrobial surgical prophylaxis in reducing SSI.

Are broad-spectrum antibiotics preoperatively reducing surgical site infection or SSI following open pancreatoduodenectomy more than standard care?

To investigate this, the researcher did the present study.

The following points explain the study summary:

• Researchers included 456 men and 322 women of median age 67 years undergoing elective open pancreatoduodenectomy.
• The study centres were located at 26 medical centres in US and Canada.
• Nine hundred sixty-seven participants were randomized, and 778 were analyzed.
• Three hundred seventy-eight participants were given Piperacillin-tazobactam 3.375 or 4.5 g intravenously within 60 min of incision and every 2-4 hours during operation until incision closure.
• Four hundred participants were given Cefoxitin 2g intravenously within 60 min of incision and every 2-4 hours during operation until incision closure.
• Surgical site infection or SSI within 30 days was the primary outcome measured in the study.
• 75/378 patients constituting 19.8 %, were given Piperacillin-Tazobactam, and 131/400 patients constituting 32.8 %, were given Cefoxitin, had 30 days postoperative SSI with an absolute difference of -13% and an odds ratio of 0.51.

They said we found a reduced percentage of SSI at 30 days in the perioperative piperacillin-tazobactam vs cefoxitin group. Those treated with piperacillin-tazobactam had lower rates of postoperative sepsis and clinically relevant postoperative pancreatic fistula.

Mortality rates at 30 days were 1.3% among those treated with piperacillin-tazobactam and 2.5% among those receiving Cefoxitin.

Overall, the study supports using piperacillin-tazobactam as perioperative prophylaxis in open pancreatoduodenectomy.

Further reading:

D’Angelica MI, Ellis RJ, Liu JB, et al. Piperacillin-Tazobactam Compared With Cefoxitin as Antimicrobial Prophylaxis for Pancreatoduodenectomy: A Randomized Clinical Trial. JAMA. 2023;329(18):1579–1588. doi:10.1001/jama.2023.5728