Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Ependorf, Hamburg, Germany.
Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Langenbecks Arch Surg. 2024 Oct 15;409(1):307. doi: 10.1007/s00423-024-03465-y.
INTRODUCTION : Surgical site infection (SSI) after pancreatoduodenectomy (PD) is a significant concern. Targeted antibiotic prophylaxis (pAP) has been tested to mitigate antibiotic resistance patterns, especially after preoperative bile duct stenting. The aim of this study was to investigate the effect of enhanced anti-infective prophylaxis (EAP) on the incidence of superficial and intraabdominal SSI.
All patients who underwent PD at a single centre between May 2018 and May 2021 were retrospectively analysed. A control cohort of patients who received pAP with intravenous cefuroxime and metronidazole and routine intraoperative abdominal lavage according to the surgeons' preferences. Since March 2020, pAP has been changed to piperacillin/tazobactam according to local resistance patterns and combined with routine intraoperative extended abdominal lavage (EIPL). Preoperative selective decontamination of the digestive tract (SDD) has been applied routinely since Jan 2019.
In total, 163 patients were included. The standard (n = 100) and EAP (n = 63) groups did not significantly differ with regard to pertinent patient and operative characteristics. In the EAP group, the rates of SSI (14% vs. 37%, p = 0.002, total rate: 28%) and urinary tract infection (24% vs. 8%, p = 0.011, total rate 18%) were significantly lower. Other septic complications were not significantly different. In addition, the risk of developing gastrointestinal bleeding and delayed gastric emptying was significantly lower in the EAP group. Multivariate analysis showed that an age > 67 years was a significant risk factor for SSI.
The results indicate that enhanced anti-infective prophylaxis may significantly decrease the incidence of SSI in patients after PD.
介绍：胰十二指肠切除术（PD）后外科部位感染（SSI）是一个重大关注点。靶向抗生素预防（pAP）已被用于减轻抗生素耐药模式，尤其是在术前胆管支架置入之后。本研究旨在调查强化抗感染预防（EAP）对浅表和腹腔内 SSI 发生率的影响。
回顾性分析了 2018 年 5 月至 2021 年 5 月在一家中心接受 PD 的所有患者。对照组患者接受静脉注射头孢呋辛和甲硝唑的 pAP，并根据外科医生的偏好进行常规术中腹腔冲洗。自 2020 年 3 月以来，根据当地耐药模式将 pAP 改为哌拉西林/他唑巴坦，并结合常规术中扩展腹腔冲洗（EIPL）。自 2019 年 1 月以来，常规应用术前选择性消化道去污（SDD）。
共纳入 163 例患者。标准（n=100）和 EAP（n=63）组在相关患者和手术特征方面无显著差异。在 EAP 组，SSI（14%比 37%，p=0.002，总发生率：28%）和尿路感染（24%比 8%，p=0.011，总发生率 18%）的发生率显著降低。其他脓毒症并发症无显著差异。此外，EAP 组发生胃肠道出血和胃排空延迟的风险显著降低。多变量分析显示，年龄>67 岁是 SSI 的显著危险因素。
结果表明，强化抗感染预防可显著降低 PD 后患者 SSI 的发生率。
