Piperacillin-Tazobactam Compared With Cefoxitin as Antimicrobial Prophylaxis for Pancreatoduodenectomy: A Randomized Clinical Trial
IMPORTANCE: Despite improvements in perioperative mortality, the incidence of postoperative surgical site infection (SSI) remains high after pancreatoduodenectomy. The effect of broad-spectrum antimicrobial surgical prophylaxis in reducing SSI is poorly understood. OBJECTIVE: To define the effect of...
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| Published in | JAMA : the journal of the American Medical Association Vol. 329; no. 18; pp. 1579 - 1588 |
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| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
American Medical Association
09.05.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0098-7484 1538-3598 1538-3598 |
| DOI | 10.1001/jama.2023.5728 |
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| Abstract | IMPORTANCE: Despite improvements in perioperative mortality, the incidence of postoperative surgical site infection (SSI) remains high after pancreatoduodenectomy. The effect of broad-spectrum antimicrobial surgical prophylaxis in reducing SSI is poorly understood. OBJECTIVE: To define the effect of broad-spectrum perioperative antimicrobial prophylaxis on postoperative SSI incidence compared with standard care antibiotics. DESIGN, SETTING, AND PARTICIPANTS: Pragmatic, open-label, multicenter, randomized phase 3 clinical trial at 26 hospitals across the US and Canada. Participants were enrolled between November 2017 and August 2021, with follow-up through December 2021. Adults undergoing open pancreatoduodenectomy for any indication were eligible. Individuals were excluded if they had allergies to study medications, active infections, chronic steroid use, significant kidney dysfunction, or were pregnant or breastfeeding. Participants were block randomized in a 1:1 ratio and stratified by the presence of a preoperative biliary stent. Participants, investigators, and statisticians analyzing trial data were unblinded to treatment assignment. INTERVENTION: The intervention group received piperacillin-tazobactam (3.375 or 4 g intravenously) as perioperative antimicrobial prophylaxis, while the control group received cefoxitin (2 g intravenously; standard care). MAIN OUTCOMES AND MEASURES: The primary outcome was development of postoperative SSI within 30 days. Secondary end points included 30-day mortality, development of clinically relevant postoperative pancreatic fistula, and sepsis. All data were collected as part of the American College of Surgeons National Surgical Quality Improvement Program. RESULTS: The trial was terminated at an interim analysis on the basis of a predefined stopping rule. Of 778 participants (378 in the piperacillin-tazobactam group [median age, 66.8 y; 233 {61.6%} men] and 400 in the cefoxitin group [median age, 68.0 y; 223 {55.8%} men]), the percentage with SSI at 30 days was lower in the perioperative piperacillin-tazobactam vs cefoxitin group (19.8% vs 32.8%; absolute difference, −13.0% [95% CI, −19.1% to −6.9%]; P < .001). Participants treated with piperacillin-tazobactam, vs cefoxitin, had lower rates of postoperative sepsis (4.2% vs 7.5%; difference, −3.3% [95% CI, −6.6% to 0.0%]; P = .02) and clinically relevant postoperative pancreatic fistula (12.7% vs 19.0%; difference, −6.3% [95% CI, −11.4% to −1.2%]; P = .03). Mortality rates at 30 days were 1.3% (5/378) among participants treated with piperacillin-tazobactam and 2.5% (10/400) among those receiving cefoxitin (difference, −1.2% [95% CI, −3.1% to 0.7%]; P = .32). CONCLUSIONS AND RELEVANCE: In participants undergoing open pancreatoduodenectomy, use of piperacillin-tazobactam as perioperative prophylaxis reduced postoperative SSI, pancreatic fistula, and multiple downstream sequelae of SSI. The findings support the use of piperacillin-tazobactam as standard care for open pancreatoduodenectomy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03269994 |
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| AbstractList | IMPORTANCE: Despite improvements in perioperative mortality, the incidence of postoperative surgical site infection (SSI) remains high after pancreatoduodenectomy. The effect of broad-spectrum antimicrobial surgical prophylaxis in reducing SSI is poorly understood. OBJECTIVE: To define the effect of broad-spectrum perioperative antimicrobial prophylaxis on postoperative SSI incidence compared with standard care antibiotics. DESIGN, SETTING, AND PARTICIPANTS: Pragmatic, open-label, multicenter, randomized phase 3 clinical trial at 26 hospitals across the US and Canada. Participants were enrolled between November 2017 and August 2021, with follow-up through December 2021. Adults undergoing open pancreatoduodenectomy for any indication were eligible. Individuals were excluded if they had allergies to study medications, active infections, chronic steroid use, significant kidney dysfunction, or were pregnant or breastfeeding. Participants were block randomized in a 1:1 ratio and stratified by the presence of a preoperative biliary stent. Participants, investigators, and statisticians analyzing trial data were unblinded to treatment assignment. INTERVENTION: The intervention group received piperacillin-tazobactam (3.375 or 4 g intravenously) as perioperative antimicrobial prophylaxis, while the control group received cefoxitin (2 g intravenously; standard care). MAIN OUTCOMES AND MEASURES: The primary outcome was development of postoperative SSI within 30 days. Secondary end points included 30-day mortality, development of clinically relevant postoperative pancreatic fistula, and sepsis. All data were collected as part of the American College of Surgeons National Surgical Quality Improvement Program. RESULTS: The trial was terminated at an interim analysis on the basis of a predefined stopping rule. Of 778 participants (378 in the piperacillin-tazobactam group [median age, 66.8 y; 233 {61.6%} men] and 400 in the cefoxitin group [median age, 68.0 y; 223 {55.8%} men]), the percentage with SSI at 30 days was lower in the perioperative piperacillin-tazobactam vs cefoxitin group (19.8% vs 32.8%; absolute difference, −13.0% [95% CI, −19.1% to −6.9%]; P < .001). Participants treated with piperacillin-tazobactam, vs cefoxitin, had lower rates of postoperative sepsis (4.2% vs 7.5%; difference, −3.3% [95% CI, −6.6% to 0.0%]; P = .02) and clinically relevant postoperative pancreatic fistula (12.7% vs 19.0%; difference, −6.3% [95% CI, −11.4% to −1.2%]; P = .03). Mortality rates at 30 days were 1.3% (5/378) among participants treated with piperacillin-tazobactam and 2.5% (10/400) among those receiving cefoxitin (difference, −1.2% [95% CI, −3.1% to 0.7%]; P = .32). CONCLUSIONS AND RELEVANCE: In participants undergoing open pancreatoduodenectomy, use of piperacillin-tazobactam as perioperative prophylaxis reduced postoperative SSI, pancreatic fistula, and multiple downstream sequelae of SSI. The findings support the use of piperacillin-tazobactam as standard care for open pancreatoduodenectomy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03269994 This phase 3 randomized clinical trial examines the effect of broad-spectrum perioperative antimicrobial prophylaxis on postoperative surgical site infection incidence compared with standard care antibiotics (cefoxitin). Despite improvements in perioperative mortality, the incidence of postoperative surgical site infection (SSI) remains high after pancreatoduodenectomy. The effect of broad-spectrum antimicrobial surgical prophylaxis in reducing SSI is poorly understood. To define the effect of broad-spectrum perioperative antimicrobial prophylaxis on postoperative SSI incidence compared with standard care antibiotics. Pragmatic, open-label, multicenter, randomized phase 3 clinical trial at 26 hospitals across the US and Canada. Participants were enrolled between November 2017 and August 2021, with follow-up through December 2021. Adults undergoing open pancreatoduodenectomy for any indication were eligible. Individuals were excluded if they had allergies to study medications, active infections, chronic steroid use, significant kidney dysfunction, or were pregnant or breastfeeding. Participants were block randomized in a 1:1 ratio and stratified by the presence of a preoperative biliary stent. Participants, investigators, and statisticians analyzing trial data were unblinded to treatment assignment. The intervention group received piperacillin-tazobactam (3.375 or 4 g intravenously) as perioperative antimicrobial prophylaxis, while the control group received cefoxitin (2 g intravenously; standard care). The primary outcome was development of postoperative SSI within 30 days. Secondary end points included 30-day mortality, development of clinically relevant postoperative pancreatic fistula, and sepsis. All data were collected as part of the American College of Surgeons National Surgical Quality Improvement Program. The trial was terminated at an interim analysis on the basis of a predefined stopping rule. Of 778 participants (378 in the piperacillin-tazobactam group [median age, 66.8 y; 233 {61.6%} men] and 400 in the cefoxitin group [median age, 68.0 y; 223 {55.8%} men]), the percentage with SSI at 30 days was lower in the perioperative piperacillin-tazobactam vs cefoxitin group (19.8% vs 32.8%; absolute difference, -13.0% [95% CI, -19.1% to -6.9%]; P < .001). Participants treated with piperacillin-tazobactam, vs cefoxitin, had lower rates of postoperative sepsis (4.2% vs 7.5%; difference, -3.3% [95% CI, -6.6% to 0.0%]; P = .02) and clinically relevant postoperative pancreatic fistula (12.7% vs 19.0%; difference, -6.3% [95% CI, -11.4% to -1.2%]; P = .03). Mortality rates at 30 days were 1.3% (5/378) among participants treated with piperacillin-tazobactam and 2.5% (10/400) among those receiving cefoxitin (difference, -1.2% [95% CI, -3.1% to 0.7%]; P = .32). In participants undergoing open pancreatoduodenectomy, use of piperacillin-tazobactam as perioperative prophylaxis reduced postoperative SSI, pancreatic fistula, and multiple downstream sequelae of SSI. The findings support the use of piperacillin-tazobactam as standard care for open pancreatoduodenectomy. ClinicalTrials.gov Identifier: NCT03269994. Despite improvements in perioperative mortality, the incidence of postoperative surgical site infection (SSI) remains high after pancreatoduodenectomy. The effect of broad-spectrum antimicrobial surgical prophylaxis in reducing SSI is poorly understood.ImportanceDespite improvements in perioperative mortality, the incidence of postoperative surgical site infection (SSI) remains high after pancreatoduodenectomy. The effect of broad-spectrum antimicrobial surgical prophylaxis in reducing SSI is poorly understood.To define the effect of broad-spectrum perioperative antimicrobial prophylaxis on postoperative SSI incidence compared with standard care antibiotics.ObjectiveTo define the effect of broad-spectrum perioperative antimicrobial prophylaxis on postoperative SSI incidence compared with standard care antibiotics.Pragmatic, open-label, multicenter, randomized phase 3 clinical trial at 26 hospitals across the US and Canada. Participants were enrolled between November 2017 and August 2021, with follow-up through December 2021. Adults undergoing open pancreatoduodenectomy for any indication were eligible. Individuals were excluded if they had allergies to study medications, active infections, chronic steroid use, significant kidney dysfunction, or were pregnant or breastfeeding. Participants were block randomized in a 1:1 ratio and stratified by the presence of a preoperative biliary stent. Participants, investigators, and statisticians analyzing trial data were unblinded to treatment assignment.Design, Setting, and ParticipantsPragmatic, open-label, multicenter, randomized phase 3 clinical trial at 26 hospitals across the US and Canada. Participants were enrolled between November 2017 and August 2021, with follow-up through December 2021. Adults undergoing open pancreatoduodenectomy for any indication were eligible. Individuals were excluded if they had allergies to study medications, active infections, chronic steroid use, significant kidney dysfunction, or were pregnant or breastfeeding. Participants were block randomized in a 1:1 ratio and stratified by the presence of a preoperative biliary stent. Participants, investigators, and statisticians analyzing trial data were unblinded to treatment assignment.The intervention group received piperacillin-tazobactam (3.375 or 4 g intravenously) as perioperative antimicrobial prophylaxis, while the control group received cefoxitin (2 g intravenously; standard care).InterventionThe intervention group received piperacillin-tazobactam (3.375 or 4 g intravenously) as perioperative antimicrobial prophylaxis, while the control group received cefoxitin (2 g intravenously; standard care).The primary outcome was development of postoperative SSI within 30 days. Secondary end points included 30-day mortality, development of clinically relevant postoperative pancreatic fistula, and sepsis. All data were collected as part of the American College of Surgeons National Surgical Quality Improvement Program.Main Outcomes and MeasuresThe primary outcome was development of postoperative SSI within 30 days. Secondary end points included 30-day mortality, development of clinically relevant postoperative pancreatic fistula, and sepsis. All data were collected as part of the American College of Surgeons National Surgical Quality Improvement Program.The trial was terminated at an interim analysis on the basis of a predefined stopping rule. Of 778 participants (378 in the piperacillin-tazobactam group [median age, 66.8 y; 233 {61.6%} men] and 400 in the cefoxitin group [median age, 68.0 y; 223 {55.8%} men]), the percentage with SSI at 30 days was lower in the perioperative piperacillin-tazobactam vs cefoxitin group (19.8% vs 32.8%; absolute difference, -13.0% [95% CI, -19.1% to -6.9%]; P < .001). Participants treated with piperacillin-tazobactam, vs cefoxitin, had lower rates of postoperative sepsis (4.2% vs 7.5%; difference, -3.3% [95% CI, -6.6% to 0.0%]; P = .02) and clinically relevant postoperative pancreatic fistula (12.7% vs 19.0%; difference, -6.3% [95% CI, -11.4% to -1.2%]; P = .03). Mortality rates at 30 days were 1.3% (5/378) among participants treated with piperacillin-tazobactam and 2.5% (10/400) among those receiving cefoxitin (difference, -1.2% [95% CI, -3.1% to 0.7%]; P = .32).ResultsThe trial was terminated at an interim analysis on the basis of a predefined stopping rule. Of 778 participants (378 in the piperacillin-tazobactam group [median age, 66.8 y; 233 {61.6%} men] and 400 in the cefoxitin group [median age, 68.0 y; 223 {55.8%} men]), the percentage with SSI at 30 days was lower in the perioperative piperacillin-tazobactam vs cefoxitin group (19.8% vs 32.8%; absolute difference, -13.0% [95% CI, -19.1% to -6.9%]; P < .001). Participants treated with piperacillin-tazobactam, vs cefoxitin, had lower rates of postoperative sepsis (4.2% vs 7.5%; difference, -3.3% [95% CI, -6.6% to 0.0%]; P = .02) and clinically relevant postoperative pancreatic fistula (12.7% vs 19.0%; difference, -6.3% [95% CI, -11.4% to -1.2%]; P = .03). Mortality rates at 30 days were 1.3% (5/378) among participants treated with piperacillin-tazobactam and 2.5% (10/400) among those receiving cefoxitin (difference, -1.2% [95% CI, -3.1% to 0.7%]; P = .32).In participants undergoing open pancreatoduodenectomy, use of piperacillin-tazobactam as perioperative prophylaxis reduced postoperative SSI, pancreatic fistula, and multiple downstream sequelae of SSI. The findings support the use of piperacillin-tazobactam as standard care for open pancreatoduodenectomy.Conclusions and RelevanceIn participants undergoing open pancreatoduodenectomy, use of piperacillin-tazobactam as perioperative prophylaxis reduced postoperative SSI, pancreatic fistula, and multiple downstream sequelae of SSI. The findings support the use of piperacillin-tazobactam as standard care for open pancreatoduodenectomy.ClinicalTrials.gov Identifier: NCT03269994.Trial RegistrationClinicalTrials.gov Identifier: NCT03269994. Importance Despite improvements in perioperative mortality, the incidence of postoperative surgical site infection (SSI) remains high after pancreatoduodenectomy. The effect of broad-spectrum antimicrobial surgical prophylaxis in reducing SSI is poorly understood. Objective To define the effect of broad-spectrum perioperative antimicrobial prophylaxis on postoperative SSI incidence compared with standard care antibiotics. Design, Setting, and Participants Pragmatic, open-label, multicenter, randomized phase 3 clinical trial at 26 hospitals across the US and Canada. Participants were enrolled between November 2017 and August 2021, with follow-up through December 2021. Adults undergoing open pancreatoduodenectomy for any indication were eligible. Individuals were excluded if they had allergies to study medications, active infections, chronic steroid use, significant kidney dysfunction, or were pregnant or breastfeeding. Participants were block randomized in a 1:1 ratio and stratified by the presence of a preoperative biliary stent. Participants, investigators, and statisticians analyzing trial data were unblinded to treatment assignment. Intervention The intervention group received piperacillin-tazobactam (3.375 or 4 g intravenously) as perioperative antimicrobial prophylaxis, while the control group received cefoxitin (2 g intravenously; standard care). Main Outcomes and Measures The primary outcome was development of postoperative SSI within 30 days. Secondary end points included 30-day mortality, development of clinically relevant postoperative pancreatic fistula, and sepsis. All data were collected as part of the American College of Surgeons National Surgical Quality Improvement Program. Results The trial was terminated at an interim analysis on the basis of a predefined stopping rule. Of 778 participants (378 in the piperacillin-tazobactam group [median age, 66.8 y; 233 {61.6%} men] and 400 in the cefoxitin group [median age, 68.0 y; 223 {55.8%} men]), the percentage with SSI at 30 days was lower in the perioperative piperacillin-tazobactam vs cefoxitin group (19.8% vs 32.8%; absolute difference, −13.0% [95% CI, −19.1% to −6.9%]; P < .001). Participants treated with piperacillin-tazobactam, vs cefoxitin, had lower rates of postoperative sepsis (4.2% vs 7.5%; difference, −3.3% [95% CI, −6.6% to 0.0%]; P = .02) and clinically relevant postoperative pancreatic fistula (12.7% vs 19.0%; difference, −6.3% [95% CI, −11.4% to −1.2%]; P = .03). Mortality rates at 30 days were 1.3% (5/378) among participants treated with piperacillin-tazobactam and 2.5% (10/400) among those receiving cefoxitin (difference, −1.2% [95% CI, −3.1% to 0.7%]; P = .32). Conclusions and Relevance In participants undergoing open pancreatoduodenectomy, use of piperacillin-tazobactam as perioperative prophylaxis reduced postoperative SSI, pancreatic fistula, and multiple downstream sequelae of SSI. The findings support the use of piperacillin-tazobactam as standard care for open pancreatoduodenectomy. |
| Author | Maithel, Shishir K Sarpel, Umut Lavu, Harish Snyder, Rebecca A Dixon, Matthew E. B D’Angelica, Michael I Cohen, Mark E Liu, Jason B Zabor, Emily C Pitt, Henry A Smith, Travis Gholami, Sepideh Ott, Mark J Chan, Carlos H. F House, Michael G Weber, Sharon M Seo, Susan K Sanford, Dominic E Dillhoff, Mary Bentrem, David J Celinski, Scott A Ko, Clifford Y Talamonti, Mark S McAuliffe, John C Reames, Bradley N Serrano, Pablo E Gönen, Mithat Behrman, Stephen W Yopp, Adam C Thompson, Vanessa M Babicky, Michele L Fernandez-del Castillo, Carlos Brajcich, Brian C Scaife, Courtney L Ellis, Ryan J Bertens, Kimberly A Karanicolas, Paul J |
| AuthorAffiliation | 20 University of Nebraska Medical Center, Omaha 8 Baylor University Medical Center, Dallas, Texas 13 University of California Davis, Sacramento 23 Huntsman Cancer Institute, Salt Lake City, Utah 15 Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada 22 Mount Sinai Medical Center, New York, New York 14 Indiana University Health, Indianapolis 26 The University of Texas MD Anderson Cancer Center, Houston 5 Northwestern University, Chicago, Illinois 2 American College of Surgeons, Chicago, Illinois 7 University of Ottawa, Ottawa, Ontario, Canada (K.A.B.) 18 Montefiore Medical Center, New York, New York 29 University of Texas Southwestern Medical Center, Dallas 28 University of Wisconsin, Madison 6 Baptist Memorial Medical Education, Memphis, Tennessee 30 Rutgers Cancer Institute of New Jersey, New Brunswick 32 Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California 9 University of Iowa Hospitals and Clinics, Iowa City 4 The Oregon Clinic/Provid |
| AuthorAffiliation_xml | – name: 16 Thomas Jefferson University, Philadelphia, Pennsylvania – name: 32 Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California – name: 8 Baylor University Medical Center, Dallas, Texas – name: 6 Baptist Memorial Medical Education, Memphis, Tennessee – name: 2 American College of Surgeons, Chicago, Illinois – name: 19 Intermountain Healthcare, Murray, Utah – name: 27 NorthShore University Health, Evanston, Illinois – name: 17 Emory University Hospital, Atlanta, Georgia – name: 9 University of Iowa Hospitals and Clinics, Iowa City – name: 28 University of Wisconsin, Madison – name: 7 University of Ottawa, Ottawa, Ontario, Canada (K.A.B.) – name: 11 Rush University Medical Center, Chicago, Illinois – name: 20 University of Nebraska Medical Center, Omaha – name: 4 The Oregon Clinic/Providence Portland Medical Center, Portland – name: 26 The University of Texas MD Anderson Cancer Center, Houston – name: 12 Massachusetts General Hospital, Boston – name: 30 Rutgers Cancer Institute of New Jersey, New Brunswick – name: 22 Mount Sinai Medical Center, New York, New York – name: 13 University of California Davis, Sacramento – name: 29 University of Texas Southwestern Medical Center, Dallas – name: 14 Indiana University Health, Indianapolis – name: 18 Montefiore Medical Center, New York, New York – name: 24 McMaster University, Hamilton, Ontario, Canada – name: 3 Brigham and Women’s Hospital, Boston, Massachusetts – name: 5 Northwestern University, Chicago, Illinois – name: 15 Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada – name: 21 Washington University School of Medicine, St Louis, Missouri – name: 1 Memorial Sloan Kettering Cancer Center, New York, New York – name: 23 Huntsman Cancer Institute, Salt Lake City, Utah – name: 10 Ohio State University Cancer Center, Columbus – name: 25 Gunderson Health System, La Crosse, Wisconsin – name: 31 Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles |
| Author_xml | – sequence: 1 givenname: Michael I surname: D’Angelica fullname: D’Angelica, Michael I – sequence: 2 givenname: Ryan J surname: Ellis fullname: Ellis, Ryan J – sequence: 3 givenname: Jason B surname: Liu fullname: Liu, Jason B – sequence: 4 givenname: Brian C surname: Brajcich fullname: Brajcich, Brian C – sequence: 5 givenname: Mithat surname: Gönen fullname: Gönen, Mithat – sequence: 6 givenname: Vanessa M surname: Thompson fullname: Thompson, Vanessa M – sequence: 7 givenname: Mark E surname: Cohen fullname: Cohen, Mark E – sequence: 8 givenname: Susan K surname: Seo fullname: Seo, Susan K – sequence: 9 givenname: Emily C surname: Zabor fullname: Zabor, Emily C – sequence: 10 givenname: Michele L surname: Babicky fullname: Babicky, Michele L – sequence: 11 givenname: David J surname: Bentrem fullname: Bentrem, David J – sequence: 12 givenname: Stephen W surname: Behrman fullname: Behrman, Stephen W – sequence: 13 givenname: Kimberly A surname: Bertens fullname: Bertens, Kimberly A – sequence: 14 givenname: Scott A surname: Celinski fullname: Celinski, Scott A – sequence: 15 givenname: Carlos H. F surname: Chan fullname: Chan, Carlos H. F – sequence: 16 givenname: Mary surname: Dillhoff fullname: Dillhoff, Mary – sequence: 17 givenname: Matthew E. B surname: Dixon fullname: Dixon, Matthew E. B – sequence: 18 givenname: Carlos surname: Fernandez-del Castillo fullname: Fernandez-del Castillo, Carlos – sequence: 19 givenname: Sepideh surname: Gholami fullname: Gholami, Sepideh – sequence: 20 givenname: Michael G surname: House fullname: House, Michael G – sequence: 21 givenname: Paul J surname: Karanicolas fullname: Karanicolas, Paul J – sequence: 22 givenname: Harish surname: Lavu fullname: Lavu, Harish – sequence: 23 givenname: Shishir K surname: Maithel fullname: Maithel, Shishir K – sequence: 24 givenname: John C surname: McAuliffe fullname: McAuliffe, John C – sequence: 25 givenname: Mark J surname: Ott fullname: Ott, Mark J – sequence: 26 givenname: Bradley N surname: Reames fullname: Reames, Bradley N – sequence: 27 givenname: Dominic E surname: Sanford fullname: Sanford, Dominic E – sequence: 28 givenname: Umut surname: Sarpel fullname: Sarpel, Umut – sequence: 29 givenname: Courtney L surname: Scaife fullname: Scaife, Courtney L – sequence: 30 givenname: Pablo E surname: Serrano fullname: Serrano, Pablo E – sequence: 31 givenname: Travis surname: Smith fullname: Smith, Travis – sequence: 32 givenname: Rebecca A surname: Snyder fullname: Snyder, Rebecca A – sequence: 33 givenname: Mark S surname: Talamonti fullname: Talamonti, Mark S – sequence: 34 givenname: Sharon M surname: Weber fullname: Weber, Sharon M – sequence: 35 givenname: Adam C surname: Yopp fullname: Yopp, Adam C – sequence: 36 givenname: Henry A surname: Pitt fullname: Pitt, Henry A – sequence: 37 givenname: Clifford Y surname: Ko fullname: Ko, Clifford Y |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37078771$$D View this record in MEDLINE/PubMed |
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| Snippet | IMPORTANCE: Despite improvements in perioperative mortality, the incidence of postoperative surgical site infection (SSI) remains high after... Despite improvements in perioperative mortality, the incidence of postoperative surgical site infection (SSI) remains high after pancreatoduodenectomy. The... Importance Despite improvements in perioperative mortality, the incidence of postoperative surgical site infection (SSI) remains high after... This phase 3 randomized clinical trial examines the effect of broad-spectrum perioperative antimicrobial prophylaxis on postoperative surgical site infection... |
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| SubjectTerms | Adult Aged Allergies Anti-Bacterial Agents - therapeutic use Antibiotics Antiinfectives and antibacterials Breast feeding Cefoxitin Cefoxitin - therapeutic use Clinical trials Complications Design standards Disease prevention Fistula Fistulae Humans Implants Infectious diseases Kidney diseases Male Mortality Online First Original Investigation Pancreas Pancreatic Fistula - drug therapy Pancreaticoduodenectomy Pancreaticoduodenectomy - adverse effects Penicillanic Acid - therapeutic use Piperacillin Piperacillin - therapeutic use Piperacillin, Tazobactam Drug Combination - therapeutic use Piperacillin-tazobactam Prophylaxis Quality control Sepsis Sepsis - drug therapy Surgery Surgical site infections Surgical Wound Infection - prevention & control Tazobactam |
| Title | Piperacillin-Tazobactam Compared With Cefoxitin as Antimicrobial Prophylaxis for Pancreatoduodenectomy: A Randomized Clinical Trial |
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