Perioperative antibiotics covering bacteriobilia reduce organ/space surgical site infection after pancreaticoduodenectomy with preoperative biliary drainage.

Abstract

The effect of perioperative antibiotics covering bacteriobilia on organ/space surgical site infection (SSI) after pancreaticoduodenectomy (PD) with preoperative biliary drainage (PBD) remains unclear. This study aimed to evaluate the effect of prophylactic antibiotics covering bacteriobilia on postoperative complications of patients undergoing PD with PBD. Clinicopathological data of patients who underwent PD with PBD between May 2019 and December 2024 were analyzed retrospectively. Risk factors of organ/space SSI were identified using univariate and multivariate analysis. Propensity score matching (PSM) with a ratio of 1:1 was conducted to minimize bias from baseline characteristics between the sufficient and insufficient antibiotic coverage groups. Based on coverage of cultured biliary bacteria, 210 (55.6%) patients received sufficient perioperative antibiotics. Organ/space SSI occurred in 204 (54.0%) patients, and perioperative antibiotics (OR = 4.353, 95%CI = 2.803-6.761, P < 0.001) were the only independent risk factor. Both before and after PSM, the group receiving sufficient antibiotics exhibited a significantly lower incidence of organ/space SSI (P < 0.05) compared to those with insufficient coverage. Postoperative cholangitis was also significantly reduced in the sufficient group (pre-PSM: 2.9% vs. 8.9%, P = 0.008; post-PSM: 3.0% vs. 7.6%, P = 0.045). Perioperative antibiotics regimens specifically targeting bile cultures reduce the risk of organ/space SSI in patients undergoing PD with PBD. Therefore, bile cultures in PBD patients can guide the optimal choice of perioperative prophylactic antibiotics to minimize organ/space SSI.