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Long term assessment of antibiotic prophylaxis and biliary microbiome in pancreaticoduodenectomy.
Said, Sayf A; Hossain, Mir S; DeMare, Alexander; Perlmutter, Breanna C; McMichael, John; Joyce, Daniel; Simon, Robert; Augustin, Toms; Walsh, R M.
Afiliación
  • Said SA; Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44120, USA.
  • Hossain MS; Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44120, USA.
  • DeMare A; Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44120, USA.
  • Perlmutter BC; Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44120, USA.
  • McMichael J; Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44120, USA.
  • Joyce D; Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44120, USA.
  • Simon R; Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44120, USA.
  • Augustin T; Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44120, USA.
  • Walsh RM; Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44120, USA. Electronic address: WALSHM@ccf.org.
HPB (Oxford) ; 24(11): 1861-1868, 2022 11.
Article en En | MEDLINE | ID: mdl-35918214
INTRODUCTION: Surgical site infections (SSI) can represent a major complication of pancreaticoduodenectomy (PD). We summarize the outcomes of process improvement efforts to reduce the SSI rates in PD that includes replacing Cefazolin with Ceftriaxone-Metronidazole as antibiotic prophylaxis. Additional efforts included current assessment of biliary microbiome and potential prophylactic failures based on bile cultures and suspected antibiotic allergies. METHOD: A single-center review of PD patients from January-2012 to March-2021. Study groups were divided into Pre and Post May-2015 (Group 1 and 2, respectively) when Ceftriaxone-Metronidazole prophylaxis and routine intraoperative cultures were standardized. Univariate and multivariable analyses were conducted to assess groups' differences and association with SSI. RESULTS: Six hundred ninety patients identified [267(38.7%) and 423(61.3%) in Group 1 and Group2, respectively]. After antibiotic change, SSI rates decreased from 28.1% to 16.5% (incisional: 17.6%-7.5%, organ-space or abscess: 17.2%-13.0%), Group 1 and Group 2, respectively, P<0.001. Ceftriaxone-Metronidazole was used in 75.9% of patients Group 2. When adjusting for other covariates, an SSI-decrease was associated only with Ceftriaxone-Metronidazole (OR 0.34, P<0.001). CONCLUSIONS: Ongoing process improvement has resulted in decreased SSIs with Ceftriaxone-Metronidazole prophylaxis. The benefit of Ceftriaxone-Metronidazole is independent of the biliary microbiome. Improving prophylaxis for those with suspected penicillin allergy is warranted.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Profilaxis Antibiótica / Microbiota Límite: Humans Idioma: En Revista: HPB (Oxford) Asunto de la revista: GASTROENTEROLOGIA Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Profilaxis Antibiótica / Microbiota Límite: Humans Idioma: En Revista: HPB (Oxford) Asunto de la revista: GASTROENTEROLOGIA Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido