De Pastena Matteo, Paiella Salvatore, Secchettin Erica, Caputo Damiano, Moraldi Luca, Azzolina Danila, Addari Laura, Carrara Elena, Azzini Anna Maria, Tirloni Luca, Coppola Roberto, Bartolini Ilenia, La Vaccara Vincenzo, Risaliti Matteo, Cammarata Roberto, Urciuoli Irene, Giani Tommaso, Esposito Alessandro, Casetti Luca, Landoni Luca, Pea Antonio, Fontana Martina, Malleo Giuseppe, Mazzariol Annarita, Gregori Dario, Angeletti Silvia, Ciccozzi Massimo, Fiammenghi Carlotta, Tacconelli Evelina, Salvia Roberto
Pancreatic Surgery Unit, University of Verona Hospital Trust, Verona, Italy.
University of Verona, Verona, Italy.
JAMA Netw Open. 2025 Jul 1;8(7):e2520149. doi: 10.1001/jamanetworkopen.2025.20149.
Antimicrobial stewardship (AMS) programs optimize antibiotic use and mitigate antimicrobial resistance. The literature on the efficacy of AMS programs in pancreatic surgery is limited.
To investigate the association of a multifaceted AMS intervention targeting surgical antibiotic prophylaxis (SAP) with the rate of surgical site infections (SSIs) following pancreatic surgery.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was a multicenter, before-and-after analysis conducted at 3 Italian centers. The intervention cohort included adult patients aged 18 years or older who underwent pancreatectomy between January 1, 2020, and December 31, 2022, while the historical cohort included patients from January 1, 2015, to December 31, 2019.
A multiprofessional, multidimensional ASM program that included a bundle of interventions and pivoted on preoperative rectal screening for multidrug-resistant bacteria and targeted SAP.
The primary outcomes were SSI incidence and SAP appropriateness, assessed through the coverage rate of rectal and biliary isolates. Data were analyzed using propensity score weighting. Secondary outcomes evaluated were other postoperative outcomes (eg, pancreatic fistula rate, length of stay), antibiotic use, and costs.
A total of 3387 patients (median [IQR] age, 66 [66-73] years; 1788 male [52.8%]) were included, with 1219 in the intervention cohort and 2168 in the historical cohort. After implementing the AMS program, a statistically significant reduction was found in rates of overall (30.1% vs 20.6%), superficial (5.8% vs 2.5%), deep (0.9% vs 0.3%), and organ-space (26.3% vs 19.3%) SSIs. After propensity score weighting, the odds ratios for the estimated mean treatment effect were 0.92 (95% CI, 0.89-0.96) for overall, 0.85 (95% CI, 0.78-0.93) for superficial, and 0.95 (95% CI, 0.92-0.99) for organ-space SSIs. Surgical antibiotic prophylaxis coverage increased significantly for rectal screening (87.2% vs 100%) and biliary bacterial colonization (59.7% vs 68.7%). Complications, infections, length of stay, and antibiotic consumption also decreased, with an overall cost savings of 247 460 euros.
These findings suggest that a multifaceted, pancreatic surgery-specific AMS program is associated with decreased rates of SSIs, increased coverage of isolated bacteria, improved clinical outcomes, more judicious antibiotic use, and lower costs.
抗菌药物管理（AMS）计划可优化抗生素使用并减轻抗菌药物耐药性。关于AMS计划在胰腺手术中疗效的文献有限。
研究针对手术预防性使用抗生素（SAP）的多方面AMS干预措施与胰腺手术后手术部位感染（SSI）发生率之间的关联。
设计、设置和参与者：这项横断面研究是在3个意大利中心进行的多中心前后分析。干预队列包括2020年1月1日至2022年12月31日期间接受胰腺切除术的18岁及以上成年患者，而历史队列包括2015年1月1日至2019年12月31日期间的患者。
一个多专业、多维度的ASM计划，包括一系列干预措施，并以术前对多重耐药菌进行直肠筛查和针对性的SAP为核心。
主要结局是SSI发生率和SAP的适宜性，通过直肠和胆汁分离株的覆盖率进行评估。使用倾向评分加权法分析数据。评估的次要结局包括其他术后结局（如胰瘘发生率、住院时间）、抗生素使用情况和成本。
共纳入3387例患者（中位年龄[四分位间距]，66[66 - 73]岁；男性1788例[52.8%]），其中干预队列1219例，历史队列2168例。实施AMS计划后，总体（30.1%对20.6%）、浅表（5.8%对2.5%）、深部（0.9%对0.3%）和器官间隙（26.3%对19.3%）SSI发生率均有统计学意义的显著降低。经过倾向评分加权后，总体估计平均治疗效应的比值比为0.92（95%置信区间，0.89 - 0.96），浅表为0.85（95%置信区间，0.78 - 0.93），器官间隙SSI为0.95（95%置信区间，0.92 - 0.99）。直肠筛查（87.2%对100%）和胆汁细菌定植（59.7%对68.7%）的手术预防性抗生素覆盖范围显著增加。并发症、感染、住院时间和抗生素消耗量也有所减少，总体节省成本247460欧元。
这些发现表明，一个多方面、针对胰腺手术的AMS计划与SSI发生率降低、分离细菌的覆盖范围增加、临床结局改善、抗生素使用更合理以及成本降低相关。
