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Risk factors for surgical site infection after pancreatic surgery: a better postoperative antibiotic strategy is possible.
Petit, M; Geri, G; Salomon, E; Victor, M; Peschaud, F; Vieillard-Baron, A; Repessé, X.
Afiliação
  • Petit M; Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France.
  • Geri G; Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France; Paris-Saclay University, Saint-Quentin en Yvelines, France; INSERM, Villejuif, France.
  • Salomon E; Paris-Saclay University, Saint-Quentin en Yvelines, France; Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Microbiology Unit, Section Biology Pathology and Health Products, Boulogne-Billancourt, France.
  • Victor M; Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Hematology-Immunology-Transfusion, Boulogne-Billancourt, France.
  • Peschaud F; Paris-Saclay University, Saint-Quentin en Yvelines, France; Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Digestive Oncological and Metabolic Surgery, Boulogne-Billancourt, France.
  • Vieillard-Baron A; Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France; Paris-Saclay University, Saint-Quentin en Yvelines, France; INSERM, Villejuif, France.
  • Repessé X; Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France. Electronic address: xavier.repesse@aphp.fr.
J Hosp Infect ; 107: 28-34, 2021 Jan.
Article em En | MEDLINE | ID: mdl-32980490
INTRODUCTION: Pancreatic surgery is associated with high morbidity, mainly due to infectious complications, so many centres use postoperative antibiotics (ATBpo) for all patients. However, antibiotic regimens vary according to local practices. The aims of this study were to describe the occurrence of surgical site infection (SSI) and ATBpo prescription after pancreatic surgery, and to determine the risk factors of postoperative SSI, in order to better define the clinical indications for ATBpo in this context. PATIENTS AND METHODS: All patients undergoing scheduled major pancreatic surgery from January 2007 to November 2018 were included in this retrospective study. Patients were classified into four groups according to SSI and routine ATBpo prescription: SSI+/ATBpo+, SSI-/ATBpo+, SSI+/ATBpo- and SSI-/ATBpo-. In addition, risk factors (fever and pre-operative biliary prosthesis) associated with the occurrence of SSI and ATBpo were analysed using a logistic regression model. RESULTS: Data from 149 patients (115 pancreaticoduodenectomies and 34 splenopancreatectomies) were analysed. Thirty (20.1%) patients experienced SSI and 42 (28.2%) received ATBpo. No difference was found in routine ATBpo prescription between patients with and without SSI (26.7% vs 28.6%, respectively; P=0.9). Amongst the 107 patients who did not receive routine ATBpo, 85 (79.4%) did not develop an SSI. In-hospital mortality did not differ between infected and uninfected patients (7% vs 2%, respectively; P=0.13). The occurrence of postoperative fever differed between SSI+ and SSI- patients (73.3% vs 34.2%, respectively; P<0.001), while the prevalence of pre-operative biliary prosthesis was similar (37.9% vs 26.7%, respectively; P=0.3). CONCLUSION: Non-routine ATBpo after major pancreatic surgery resulted in 85 (56%) patients being spared unnecessary antibiotic treatment. This suggests that routine ATBpo prescription could be excessive, but further studies are needed to confirm such antibiotic stewardship. Fever appears to be a relevant clinical sign for individual-based prescription, but the presence of a biliary prosthesis does not.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Procedimentos Cirúrgicos do Sistema Digestório / Infecção da Ferida Cirúrgica / Antibioticoprofilaxia / Gestão de Antimicrobianos Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: J Hosp Infect Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Procedimentos Cirúrgicos do Sistema Digestório / Infecção da Ferida Cirúrgica / Antibioticoprofilaxia / Gestão de Antimicrobianos Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: J Hosp Infect Ano de publicação: 2021 Tipo de documento: Article