Perioperative antibiotics for surgical site infection in pancreaticoduodenectomy: Does the SCIP-approved regimen provide adequate coverage?

Abstract

Introduction-The Joint Commission Surgical Care Improvement Project (SCIP) includes performance measures aimed at reducing surgical site infections (SSI). One measure defines approved perioperative antibiotics for general operative procedures. However, there may be a subset of procedures not adequately covered with the use of approved antibiotics. We hypothesized that piperacillin-tazobactam is a more appropriate perioperative antibiotic for pancreaticoduodenectomy (PD).

Microbiology of pancreatoduodenectomy and recommendations for antimicrobial prophylaxis

“…Surgical site infections occurred in nine of 44 (20%) patients, which lies within the broad range of incidence reported in the literature of 6–50% . Blood culture and surgical site infection site culture isolates correlated with at least one intraoperative specimen culture isolate in seven of 10 (70%) patients, which is comparable to the correlation rate of 30–59% reported in other studies …”

“…Age, sex, tumour factors, neoadjuvant chemotherapy, preoperative biliary stenting, surgery type, surgeon and perioperative antimicrobial prophylaxis coverage of intraoperative specimen culture isolates were not associated with any statistically significant difference in outcomes. Conversely, several retrospective observational studies have demonstrated that adjustment of perioperative antimicrobial prophylaxis regimens to cover the micro‐organisms isolated from pre‐ and intraoperative and surgical site infection specimen cultures decreases the incidence of surgical site infections . In another retrospective observational study, multivariate analysis demonstrated that intraoperative bile specimen culture isolate resistance to perioperative antimicrobial prophylaxis was the only statistically significant independent risk factor for surgical site infection .…”

Disparities in the management and prophylaxis of surgical site infection and pancreatic fistula after pancreatoduodenectomy

“…In this survey, most surgeons (57%) prefer the standard agents (cephalosporin with or without metronidazole). However, piperacillin‐tazobactam was shown to be superior in reducing SSI after PD as it covers Enteroccoccus and Enterobacter sp., which are not covered by SCIP‐approved perioperative antibiotics . In this cohort, only 9% of experts use piperacillin‐tazobactam as prophylactic antibiotic.…”

“…Surgical site infections following PD vary from 7 to 32% , and contribute to increased length of hospital stay and re‐admissions . The presence of a postoperative SSI increases hospital costs by 32.4% after PD .…”

“…Our survey assessed the variations in practice patterns related to postoperative SSI and POPF including antibiotic use (therapeutic and prophylactic), fluid cultures, management of intraoperative drains and perioperative wound care. Surgical site infections following PD vary from 7 to 32% [6], and contribute to increased length of hospital stay and re-admissions [7]. The presence of a postoperative SSI increases hospital costs by 32.4% after PD [8].…”