Role of standardized broad spectrum prophylaxis in patients with biliary drainage undergoing pancreatic surgery. A single center experience

Abstract

Introduction: Biliary tree colonization by multidrug-resistant germs (MDR) frequently follows biliary stent placement and may negatively impact on overall outcome after pancreatic surgery. The role of a standardized broad spectrum antibiotic prophylaxis in this subgroup of patients is still unknown. Methods: Between July 2016 and August 2017 intraoperative bile culture was routinely performed on 56 consecutive patients undergoing either pancreaticoduodenectomy or total pancreatectomy for pancreatic malignancies. We administered a standard antibiotic prophylaxis (Amoxicillin/Clavulanic acid) for unstented patients (group A) and a broad spectrum association (Tazobactam/Piperacillin plus Fluconazole ) for those patients who had preoperatively undergone biliary drainage (group B). Perioperative data were prospectively collected and statistically analysed. Results: 20 (35.7%) patients were in group A and 36 (64.3%) in group B. Group B showed a significantly higher incidence of MDR bile colonization if compared to group A (n = 23 (63.9%) vs 1 (5%); P < 0.0001). However, broad spectrum antibiotic prophylaxis revealed to be fully appropriate in 83.3% of group A patients, based on MDR's antibiograms. No statistically differences were found between the two groups comparing median length of stay (12 vs 13 days; P = 0.843), mortality rate (0% vs 2,8%; P = 1.000), post-operative complications (80% vs 66.7%; P=0.453) and pancreatic fistula rate (35% vs 25%; P=0.628). Conclusion: Our series seems to show that preoperative broad spectrum prophylaxis based on Tazobactam/Piperacillin plus Fluconazole may prevent a negative impact on overall surgical outcome by MDR infection secondary to preoperative biliary stenting. However, further prospective trials are needed to achieve firm evidences.