Dual‐center randomized clinical trial exploring the optimal duration of antimicrobial prophylaxis in patients undergoing pancreaticoduodenectomy following biliary drainage

OBJECTIVES: The aim of this dual‐center randomized controlled trial was to determine the optimal duration of antimicrobial prophylaxis in patients treated with pancreaticoduodenectomy (PD) who underwent preoperative biliary drainage (PBD) but were without cholangitis. BACKGROUND: Some reports showed that PBD in patients undergoing pancreatectomy increased the rate of perioperative complications. However, no clinical trial has evaluated the optimal duration of antimicrobial prophylaxis with a focus on patients who underwent PD following PBD. METHODS: A total of 82 patients who underwent PD between March 2012 and December 2016 were randomly assigned to either a 1‐day group (n = 40), in which cefozopran (CZOP) as antimicrobial prophylaxis was given only on the day of surgery, or a 5‐day group (n = 42), in which CZOP was given for 5 consecutive days beginning on the day of surgery. We evaluated the incidence of infectious and other complications after PD. RESULTS: Outcomes were significantly better in the 1‐day group compared with the 5‐day group (P < 0.05) in terms of the incidence of overall infectious complications (15% vs 36%, respectively), intra‐abdominal abscess (3% vs 21%, respectively), clinically relevant postoperative pancreatic fistula (8% vs 24%, respectively), and Clavien‐Dindo grade III‐V complications (10% vs 31%, respectively). Duration of postoperative hospital stay was significantly shorter in the 1‐day group (10 days vs 15 days, P = 0.018). Anaerobic bacteria and methicillin‐resistant cocci were isolated from the drainage fluid only among patients in the 5‐day group. CONCLUSION: Single‐day prophylactic use of CZOP is appropriate for patients who undergo PD following PBD without preoperative cholangitis.