Impact of Prophylactic Cefepime on Surgical Site Infection and Severe Morbidity in Patients Who Underwent Pancreaticoduodenectomy With Preoperative Biliary Drainage.

BACKGROUND: Although prophylactic broad-spectrum antibiotics can reduce postoperative complications after pancreaticoduodenectomy (PD), the optimal regimen remains uncertain. This study evaluated the impact of prophylactic cefepime (CFPM) on surgical site infection (SSI) and severe morbidity after PD with preoperative biliary drainage.

METHODS: Among 352 patients who underwent PD from 2010 to 2023, 163 patients met the inclusion criteria. Cefmetazole (CMZ) or cefazolin (CEZ) were administered as prophylactic antibiotics before May 2016, and CFPM thereafter. Short-term outcomes were compared between patients receiving CMZ/CEZ and those receiving CFPM. Risk factors for SSI and severe morbidity were assessed by multivariate logistic regression.

RESULTS: The CFPM group (n = 100) had more neoadjuvant chemotherapy, a higher rate of metallic stent placement, and a longer interval between initial biliary drainage and surgery, but less portal vein resection, lower blood loss, and fewer transfusions than the CMZ/CEZ group. Rates of superficial/deep incisional SSI and organ/space SSI were markedly lower with CFPM (3.0% vs. 44.4%, p < 0.001; and 10.0% vs. 36.5%, p < 0.001, respectively), which were associated with a reduction in Enterobacter cloacae infection. Severe morbidity was also reduced in the CFPM group (18.0% vs. 39.7%, p = 0.002). Use of CMZ/CEZ was independently associated with increased SSI and severe morbidity (OR = 10.6, p < 0.001; and OR = 3.53, p = 0.001). Emergence of resistant organisms did not differ between groups.

CONCLUSIONS: Prophylactic CFPM may reduce SSIs and severe morbidity after PD with preoperative biliary drainage.