Piperacillin/tazobactam for surgical prophylaxis during pancreatoduodenectomy: meta-analysis.

Autor:	Kumar J; Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK.; Department of General Surgery, Memorial Healthcare System, Pembroke Pines, Florida, USA., Reccia I; General Surgery and Oncologic Unit, Policlinico ponte San Pietro, Bergamo, Italy., Carneiro A; Department of Surgery, Federal University of Pernambuco, Recife, Brazil., Podda M; Department of Surgery, Calgiari University Hospital, Calgiari, Italy., Virdis F; Dipartimento DEA-EAS, Ospedale Niguarda Ca' Granda Milano, Milano, Italy., Machairas N; Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece., Nasralla D; Department of HPB Surgery, Royal Free Hospital, London, UK., Arasaradnam RP; Warwick Medical School, University of Warwick, Coventry, UK.; Institute of Precision Diagnostics & Translational Medicine, Coventry, UK., Poon K; Division of Infectious Disease, Memorial Healthcare System, Pembroke Pines, Florida, USA., Gannon CJ; Department of General Surgery, Memorial Healthcare System, Pembroke Pines, Florida, USA., Fung JJ; Department of Surgery, The Transplantation Institute, University of Chicago, Chicago, Illinois, USA., Habib N; Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK., Llaguna O; Department of General Surgery, Memorial Healthcare System, Pembroke Pines, Florida, USA.
Jazyk:	angličtina
Zdroj:	BJS open [BJS Open] 2024 May 08; Vol. 8 (3).
DOI:	10.1093/bjsopen/zrae066
Abstrakt:	Background: Pancreatoduodenectomy is associated with an increased incidence of surgical-site infections, often leading to a significant rise in morbidity and mortality. This trend underlines the inadequacy of traditional antibiotic prophylaxis strategies. Hence, the aim of this meta-analysis was to assess the outcomes of antimicrobial prophylaxis, comparing piperacillin/tazobactam with traditional antibiotics. Methods: Upon registering in PROSPERO, the international prospective register of systematic reviews (CRD42023479100), a systematic search of various databases was conducted over the interval 2000-2023. This inclusive search encompassed a wide range of study types, including prospective and retrospective cohorts and RCTs. The subsequent data analysis was carried out utilizing RevMan 5.4. Results: A total of eight studies involving 2382 patients who underwent pancreatoduodenectomy and received either piperacillin/tazobactam (1196 patients) or traditional antibiotics (1186 patients) as antibiotic prophylaxis during surgery were included in the meta-analysis. Patients in the piperacillin/tazobactam group had significantly reduced incidences of surgical-site infections (OR 0.43 (95% c.i. 0.30 to 0.62); P < 0.00001) and major surgical complications (Clavien-Dindo grade greater than or equal to III) (OR 0.61 (95% c.i. 0.45 to 0.81); P = 0.0008). Subgroup analysis of surgical-site infections highlighted significantly reduced incidences of superficial surgical-site infections (OR 0.34 (95% c.i. 0.14 to 0.84); P = 0.02) and organ/space surgical-site infections (OR 0.47 (95% c.i. 0.28 to 0.78); P = 0.004) in the piperacillin/tazobactam group. Further, the analysis demonstrated significantly lower incidences of clinically relevant postoperative pancreatic fistulas (grades B and C) (OR 0.67 (95% c.i. 0.53 to 0.83); P = 0.0003) and mortality (OR 0.51 (95% c.i. 0.28 to 0.91); P = 0.02) in the piperacillin/tazobactam group. Conclusion: Piperacillin/tazobactam as antimicrobial prophylaxis significantly lowers the risk of postoperative surgical-site infections, major surgical complications (complications classified as Clavien-Dindo grade greater than or equal to III), clinically relevant postoperative pancreatic fistulas (grades B and C), and mortality, hence supporting the implementation of piperacillin/tazobactam for surgical prophylaxis in current practice. (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)
Databáze:	MEDLINE
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