Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan.
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan.
Surgery. 2019 Mar;165(3):559-564. doi: 10.1016/j.surg.2018.09.011. Epub 2018 Oct 26.
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.
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.
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.
The prophylactic administration of third-generation cephalosporin reduced the incidence of surgical site infection after pancreatoduodenectomy in patients who underwent preoperative endoscopic biliary stenting.
本研究旨在探讨对于术前胆道引流后胆汁培养结果未知的患者，在预防性应用抗生素时将第三代头孢菌素替代头孢唑林，是否会降低胰十二指肠切除术后手术部位感染的发生率。
本回顾性研究纳入了 138 例行内镜下胆道支架置入术且近期术前胆汁培养结果未知的胰十二指肠切除术患者，2010 年至 2014 年（n=69）期间，所有患者均接受头孢唑林钠作为围手术期预防性抗生素治疗；2014 年至 2017 年（n=69）期间，根据院内培养监测结果，所有患者均接受头孢曲松治疗。比较两组患者的手术部位感染发生率，并评估手术部位感染的危险因素。
头孢曲松组的总体手术部位感染发生率明显低于头孢唑林钠组，其中 Clavien-Dindo 分级≥Ⅱ（28% vs. 52%，P=0.005）和 Clavien-Dindo 分级≥Ⅲa（20% vs. 41%，P=0.016）患者的感染发生率均较低。多因素分析显示，头孢唑林钠预防性应用与 Clavien-Dindo 分级≥Ⅱ和 Clavien-Dindo 分级≥Ⅲa患者的总体手术部位感染发生率升高相关（优势比 2.56，P=0.019；优势比 3.03，P=0.020）。在头孢唑林钠组中，大多数接受术前培养的患者为对头孢唑林钠固有耐药的肠杆菌科细菌，而这些细菌对头孢曲松的敏感性较高。
对于术前接受内镜下胆道支架置入术的患者，预防性应用第三代头孢菌素可降低胰十二指肠切除术后手术部位感染的发生率。
