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

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-05-08 DOI:10.1093/bjsopen/zrae066
Jayant Kumar, Isabella Reccia, Adriano Carneiro, Mauro Podda, Francesco Virdis, Nikolaos Machairas, David Nasralla, Ramesh P Arasaradnam, Kenneth Poon, Christopher J Gannon, John J Fung, Nagy Habib, Omar Llaguna
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引用次数: 0

Abstract

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.

哌拉西林/他唑巴坦用于胰十二指肠切除术期间的手术预防:荟萃分析。
背景:胰十二指肠切除术与手术部位感染发生率增加有关,往往导致发病率和死亡率显著上升。这一趋势凸显了传统抗生素预防策略的不足。因此,本荟萃分析旨在通过比较哌拉西林/他唑巴坦与传统抗生素,评估抗菌药预防的效果:在国际系统综述前瞻性登记册 PROSPERO(CRD42023479100)中登记后,对 2000-2023 年间的各种数据库进行了系统检索。该检索涵盖了多种研究类型,包括前瞻性和回顾性队列研究以及研究性临床试验。随后利用 RevMan 5.4 进行了数据分析:荟萃分析共纳入了 8 项研究,涉及 2382 例接受胰十二指肠切除术的患者,这些患者在手术期间接受了哌拉西林/他唑巴坦(1196 例)或传统抗生素(1186 例)作为抗生素预防。哌拉西林/他唑巴坦组患者的手术部位感染(OR 0.43 (95% c.i. 0.30 to 0.62);P < 0.00001)和主要手术并发症(Clavien-Dindo 分级大于或等于 III)(OR 0.61 (95% c.i. 0.45 to 0.81);P = 0.0008)发生率明显降低。手术部位感染亚组分析显示,哌拉西林/他唑巴坦组的浅表手术部位感染(OR 0.34 (95% c.i. 0.14 to 0.84); P = 0.02)和器官/间隙手术部位感染(OR 0.47 (95% c.i. 0.28 to 0.78); P = 0.004)发生率明显降低。此外,分析表明哌拉西林/他唑巴坦组术后临床相关的胰瘘(B级和C级)发生率(OR值为0.67(95% 置信区间为0.53-0.83);P = 0.0003)和死亡率(OR值为0.51(95% 置信区间为0.28-0.91);P = 0.02)均明显低于哌拉西林/他唑巴坦组:结论:哌拉西林/他唑巴坦作为抗菌药物预防可显著降低术后手术部位感染、主要手术并发症(Clavien-Dindo分级大于或等于III级的并发症)、临床相关的术后胰瘘(B级和C级)和死亡率的风险,因此支持在当前实践中将哌拉西林/他唑巴坦用于手术预防。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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