PROPHYLACTIC ANTIBIOTICS FOR PANCREATECTOMY AND SSI RATES
Samantha Baker*, Frank Gleason, Lauren Wood, Joshua Richman, Melanie Morris, Carlo M. Contreras
General Surgery, University of Alabama, Birmingham, AL
Introduction: High-quality level I data regarding the type of antibiotic prophylaxis for pancreatic resections are sparse, and current guidelines are largely based on recommendations for colorectal operations. From 2013 through March 2016 our institutional tendency was to administer ertapenem prophylaxis for pancreatic resection. In 2016 our institution aligned antibiotic prophylaxis recommendations with the 2013 American Society of Health-System Pharmacists (ASHP) guidelines. From March 2016 to the present our updated institutional guidelines stipulate cefazolin-based antibiotic prophylaxis. We hypothesized that the change from ertapenem- to cefazolin-based antibiotic prophylaxis from would impact the surgical site infection (SSI) rate after pancreatic resection.
Methods: All patients undergoing pancreatic resection (pancreaticoduodenectomy [PD] and distal pancreatectomy [DP]) were analyzed by National Surgical Quality Improvement Program (NSQIP) at our institution between 2013-2018 and were included. Patients were stratified based on preoperative antibiotic given as cefazolin only vs. ertapenem only vs. other (any combination that includes cefazolin, ertapenem, or neither) and type of pancreatic operation (PD vs. DP). Surgical Site Infections were defined according to NSQIP definitions. Chi-squared test was used for categorical variables and student t-test for continuous variables. Outcomes were analyzed separately based on the primary operation.
Results: 670 patients were included in the study with a median age of 64 (IQR: 55-70); 54% were female (n=359), the majority were white (79.4%, n=532). When stratified by preoperative antibiotic, 366 patients (55%) received ertapenem, 108 patients (16%) received cefazolin, and 196 patients (29%) were classified as other. Of the 474 patients who received ertapenem alone or cefazolin alone, 61% (n=288) underwent PD and the remainder underwent DP (n= 186, 39%). For patients who underwent a DP (n=186; 104 cefazolin and 82 ertapenem), there were a total of 7 post-op superficial SSI with no difference between antibiotic groups (cefazolin: 4 vs. ertapenem: 3, p=1.0). However, there were a total of 21 deep/organ space infections with those who received ertapenem being more likely (cefazolin: 6 vs. ertapenem: 15, p=0.01). Patients who underwent PD (n=288; 4 cefazolin and 284 ertapenem), those who received ertapenem preoperative were more likely to have a post-op superficial SSI (cefazolin: 2 vs. ertapenem: 13, p=0.01), but no difference in deep/organ space infections was seen between groups (cefazolin:1 vs. ertapenem:35, p=0.42).
Conclusion: Post-operative SSI rates for patients undergoing pancreatic resection differed between antibiotic groups. This confirmed our hypothesis that the increased rate in SSI was associated with the institutional prophylactic antibiotic regimen change from ertapenem to cefazolin.
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