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Antibiotic Prophylaxis for Hepato-Biliopancreatic Surgery—A Systematic Review

Background: Surgical site infections (SSIs) are among the most important determinants of morbidity after HBP surgery. Their frequency after HPB surgery is variable, from 1–2% after elective cholecystectomy to 25% after PD. Methods: A systematic review was performed to assess the role of antimicrobia...

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Autores principales: Steccanella, Francesca, Amoretti, Paolo, Barbieri, Maria Rachele, Bellomo, Fabio, Puzziello, Alessandro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8868388/
https://www.ncbi.nlm.nih.gov/pubmed/35203797
http://dx.doi.org/10.3390/antibiotics11020194
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author Steccanella, Francesca
Amoretti, Paolo
Barbieri, Maria Rachele
Bellomo, Fabio
Puzziello, Alessandro
author_facet Steccanella, Francesca
Amoretti, Paolo
Barbieri, Maria Rachele
Bellomo, Fabio
Puzziello, Alessandro
author_sort Steccanella, Francesca
collection PubMed
description Background: Surgical site infections (SSIs) are among the most important determinants of morbidity after HBP surgery. Their frequency after HPB surgery is variable, from 1–2% after elective cholecystectomy to 25% after PD. Methods: A systematic review was performed to assess the role of antimicrobial prophylaxis (AP) in HPB elective surgery. Articles published between 2015 and 2021 were obtained; those before 2015 were not included because they antedate the WHO guidelines on SSI prevention. We conducted three different research methods for liver resection, elective cholecystectomy and pancreatic and biliary surgery regarding patients requiring preoperative biliary drainage. Results: Hepatic surgery, improvement in surgical technique and perioperative management lead to a very low SSI. One preoperative 2 g cefazolin dose may be adequate for surgical prophylaxis. From preoperative biliary drainage, we can derive that patients’ homeostasis rather than AP plays a paramount role in reducing postoperative morbidity. The time from biliary drainage could be an essential element in decision making for surgical prophylaxis. In the case of low-risk cholecystectomy, it is not easy to draw definitive conclusions about the effect of AP. Data from the literature are inconsistent, and some risk factors cannot be predicted before surgery. Conclusion: in our opinion, a strict preoperative cefazolin dose strategy can be reasonable in HBP surgery until a large-scale, multicentric RCT brings definitive conclusions.
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spelling pubmed-88683882022-02-25 Antibiotic Prophylaxis for Hepato-Biliopancreatic Surgery—A Systematic Review Steccanella, Francesca Amoretti, Paolo Barbieri, Maria Rachele Bellomo, Fabio Puzziello, Alessandro Antibiotics (Basel) Systematic Review Background: Surgical site infections (SSIs) are among the most important determinants of morbidity after HBP surgery. Their frequency after HPB surgery is variable, from 1–2% after elective cholecystectomy to 25% after PD. Methods: A systematic review was performed to assess the role of antimicrobial prophylaxis (AP) in HPB elective surgery. Articles published between 2015 and 2021 were obtained; those before 2015 were not included because they antedate the WHO guidelines on SSI prevention. We conducted three different research methods for liver resection, elective cholecystectomy and pancreatic and biliary surgery regarding patients requiring preoperative biliary drainage. Results: Hepatic surgery, improvement in surgical technique and perioperative management lead to a very low SSI. One preoperative 2 g cefazolin dose may be adequate for surgical prophylaxis. From preoperative biliary drainage, we can derive that patients’ homeostasis rather than AP plays a paramount role in reducing postoperative morbidity. The time from biliary drainage could be an essential element in decision making for surgical prophylaxis. In the case of low-risk cholecystectomy, it is not easy to draw definitive conclusions about the effect of AP. Data from the literature are inconsistent, and some risk factors cannot be predicted before surgery. Conclusion: in our opinion, a strict preoperative cefazolin dose strategy can be reasonable in HBP surgery until a large-scale, multicentric RCT brings definitive conclusions. MDPI 2022-02-01 /pmc/articles/PMC8868388/ /pubmed/35203797 http://dx.doi.org/10.3390/antibiotics11020194 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Steccanella, Francesca
Amoretti, Paolo
Barbieri, Maria Rachele
Bellomo, Fabio
Puzziello, Alessandro
Antibiotic Prophylaxis for Hepato-Biliopancreatic Surgery—A Systematic Review
title Antibiotic Prophylaxis for Hepato-Biliopancreatic Surgery—A Systematic Review
title_full Antibiotic Prophylaxis for Hepato-Biliopancreatic Surgery—A Systematic Review
title_fullStr Antibiotic Prophylaxis for Hepato-Biliopancreatic Surgery—A Systematic Review
title_full_unstemmed Antibiotic Prophylaxis for Hepato-Biliopancreatic Surgery—A Systematic Review
title_short Antibiotic Prophylaxis for Hepato-Biliopancreatic Surgery—A Systematic Review
title_sort antibiotic prophylaxis for hepato-biliopancreatic surgery—a systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8868388/
https://www.ncbi.nlm.nih.gov/pubmed/35203797
http://dx.doi.org/10.3390/antibiotics11020194
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