Antibiotic Prophylaxis with Piperacillin–Tazobactam Reduces Post-Operative Infectious Complication after Pancreatic Surgery: An Interventional,Non-Randomized Study

Abstract

Background:

This study aimed to evaluate the effectiveness of piperacillin–tazobactam as antibiotic prophylaxis in patients affected by a peri-ampullary tumor submitted to pancreatic surgery.

Methods:

A prospective, non-randomized, non-blinded, interventional study was conducted from January 2015 to March 2018. Patients were screened pre-operatively for Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBL-PE). During the baseline period (January 2015–October 2016), surgical prophylaxis was performed with ampicillin–sulbactam. In the intervention phase (November 2016–March 2018), patients received piperacillin–tazobactam. Statistical analysis was performed by univariable and multivariable analysis with logistic regression models.

Results:

Overall, 383 patients were included in the baseline period and 296 in the intervention period. The surveillance strategy identified 47 ESBL-PE carriers (14%) in the baseline phase and 29 (10%) in the intervention phase. In the baseline period, the patients had a higher rate of hospital-acquired infection (43% versus 33%; p = 0.004), superficial surgical site infection (SSI) (11% versus 2%; p < 0.001), and pneumonia (16% versus 9%; p = 0.006). After the logistic regression, the baseline group had an odds ratio to develop superficial SSI and pneumonia of 7.7 (95% confidence interval [CI] 3–20) and 1.8 (95% CI 1–3.3), respectively. The ESBL colonization increased the mortality rate significantly (8% versus 3%; p = 0.017).

Conclusions:

Adopting antibiotic prophylaxis based on piperacillin–tazobactam is associated with a reduction in post-operative SSI, particularly superficial-SSIs. Further randomized studies would be warranted to evaluate this antibiotic combination more extensively in preventive strategies.