Global practices in antibiotic prophylaxis for pancreatoduodenectomy: insights from an international survey among HPB surgeons.

BACKGROUND

Optimizing antibiotic prophylaxis might improve outcomes after pancreatoduodenectomy. Current guidelines lack clear recommendations regarding the type and duration of prophylaxis. This survey evaluated global practices for antibiotic prophylaxis in pancreatoduodenectomy.

METHODS

An online survey among members of international surgical associations was distributed from April to September 2024. Sixteen questions addressed intraoperative and prolonged antibiotic prophylaxis practices. Responses were analyzed descriptively and compared across continents and center volumes.

RESULTS

A total of 215 surgeons participated. Piperacillin-tazobactam was the most commonly used intraoperative antibiotic (44%), with variations across continents (North America: 68%, Europe: 29%, Asia: 22%). Prolonged prophylaxis was always used by 13% and selectively used by 66% of the surgeons with indications being mainly perioperative signs of infection (45%) or preoperative biliary drainage (55%). Piperacillin-tazobactam was preferred as prolonged prophylaxis (47%), mostly during five days (25%). Bile cultures were routinely obtained by 47% of the surgeons. Antibiotic prophylaxis was routinely adjusted based on bile culture results by 22% of the surgeons.

CONCLUSION

Global variations in perioperative antibiotic practices indicate a lack of consensus regarding antibiotic prophylaxis for pancreatoduodenectomy. Further research is required to clarify the effect of targeted antibiotic prophylaxis for patients with contaminated bile, while preserving antibiotic stewardship.