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. 2023 Oct 10;110(11):1458-1466.
doi: 10.1093/bjs/znad213.

Prolonged antibiotic prophylaxis after pancreatoduodenectomy: systematic review and meta-analysis

Daphne H M Droogh  1 , Jesse V Groen  1 , Mark G J de Boer  2 , Joffrey van Prehn  3 , Hein Putter  4 , Bert A Bonsing  1 , Casper H J van Eijck  5 , Alexander L Vahrmeijer  1 , Hjalmar C van Santvoort  6 , Bas Groot Koerkamp  5 , J Sven D Mieog  1
Affiliations

Prolonged antibiotic prophylaxis after pancreatoduodenectomy: systematic review and meta-analysis

Daphne H M Droogh et al. Br J Surg. .

Abstract

Background: Previous studies have reported conflicting results of prolonged antibiotic prophylaxis on infectious complications after pancreatoduodenectomy. This study evaluated the effect of prolonged antibiotics on surgical-site infections (SSIs) after pancreatoduodenectomy.

Methods: A systematic review and meta-analysis was undertaken of SSIs in patients with perioperative (within 24 h) versus prolonged antibiotic (over 24 h) prophylaxis after pancreatoduodenectomy. SSIs were classified as organ/space infections or superficial SSI within 30 days after surgery. ORs were calculated using a Mantel-Haenszel fixed-effect model.

Results: Ten studies were included in the qualitative analysis, of which 8 reporting on 1170 patients were included in the quantitative analysis. The duration of prolonged antibiotic prophylaxis varied between 2 and 10 days after surgery. Four studies reporting on 782 patients showed comparable organ/space infection rates in patients receiving perioperative and prolonged antibiotics (OR 1.35, 95 per cent c.i. 0.94 to 1.93). However, among patients with preoperative biliary drainage (5 studies reporting on 577 patients), organ/space infection rates were lower with prolonged compared with perioperative antibiotics (OR 2.09, 1.43 to 3.07). Three studies (633 patients) demonstrated comparable superficial SSI rates between patients receiving perioperative versus prolonged prophylaxis (OR 1.54, 0.97 to 2.44), as well as in patients with preoperative biliary drainage in 4 studies reporting on 431 patients (OR 1.60, 0.89 to 2.88).

Conclusion: Prolonged antibiotic prophylaxis is associated with fewer organ/space infection in patients who undergo preoperative biliary drainage. However, the optimal duration of antibiotic prophylaxis after pancreatoduodenectomy remains to be determined and warrants confirmation in an RCT.

Plain language summary

Almost 40 in 100 patients develop an infection after pancreatic surgery. This study collected research that studied the effect of prolonged antibiotics after pancreatic surgery on the number of infections after surgery. Research articles were selected if patients who received antibiotics only during surgery were compared with those who had prolonged antibiotics after surgery. Prolonged antibiotics means antibiotics for longer than 24 h after surgery. Comparing patients who had antibiotics during surgery and those who received prolonged antibiotics after surgery, this study focused on the number of abdominal infections and wound infections. Ten studies were selected, and these studies included 1170 patients in total. The duration of prolonged antibiotics ranged from 2 to 5 days after pancreatic surgery. Four studies (with 782 patients) showed comparable abdominal infections in patients who had antibiotics only during surgery and those who had prolonged antibiotics after surgery (OR 1.35, 95 per cent c.i. 0.94 to 1.93). However, for patients with a stent in the bile duct (5 studies on 577 patients), fewer abdominal infections were seen in patients who had prolonged antibiotics after surgery compared with patients who received antibiotics only during surgery (OR 2.09, 1.43 to 3.07). Three studies (633 patients) showed the same rate of wound infections in patients who had antibiotics only during surgery compared with those who received prolonged antibiotics after operation (OR 1.54, 0.97 to 2.44). The number of wound infections was also the same in patients with a stent in the bile duct (OR 1.60, 0.89 to 2.88). Prolonged antibiotics after pancreatic surgery seem to lower abdominal infections in patients who have a stent placed in the bile duct. However, the best duration of antibiotics is unclear; a decent study is needed.

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Figures

Fig. 1
Fig. 1
PRISMA diagram showing selection of articles for review
Fig. 2
Fig. 2
Forest plots showing occurrence of organ/space infection, superficial surgical-site infection, postoperative pancreatic fistula, and bacteraemia in patients with perioperative versus prolonged prophylaxis a Organ/space infection (OSI), b superficial surgical-site infection (SSI), c postoperative pancreatic fistula (POPF), and c bacteraemia. For each complication, results are shown for all patients undergoing pancreatoduodenectomy and only in those who underwent preoperative biliary drainage. A Mantel–Haenszel fixed-effect model was used for meta-analysis. ORs are shown with 95% confidence intervals. AB, antibiotics.
See this image and copyright information in PMC

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