piperacillin--tazobactam-drug-combination and Pancreatic-Neoplasms

Surgical site infection after pancreaticoduodenectomy is often caused by pathogens resistant to standard prophylactic antibiotics, suggesting that broad-spectrum antibiotics may be more effective prophylactic agents. This article describes the rationale and methodology underlying a multicenter randomized trial evaluating piperacillin-tazobactam compared with cefoxitin for surgical site infection prevention following pancreaticoduodenectomy. As the first US randomized surgical trial to utilize a clinical registry for data collection, this study serves as proof of concept for registry-based clinical trials.

Topics: Antibiotic Prophylaxis; Cefoxitin; Clinical Trials, Phase III as Topic; Humans; Pancreatic Neoplasms; Pancreaticoduodenectomy; Piperacillin, Tazobactam Drug Combination; Randomized Controlled Trials as Topic; Registries; Surgical Wound Infection

Bacterial peritonitis, an infection of the ascitic fluid, can be classified etiologically as spontaneous or secondary bacterial peritonitis. The former is mainly caused by portal hypertension and its subsequent effects, whereas the latter is caused by the direct dissemination of bacteria into the peritoneal cavity. Previous reports have described some distinguishing features of these two entities. Here, we report the first known case of bacterial peritonitis with Aeromonas hydrophilia and Escherichia coli in a patient with malignant ascites associated with pancreatic carcinoma who exhibited features of both spontaneous and secondary peritonitis. Our report suggests that clinicians should also consider bacterial peritonitis in patients with malignant ascites who present with ostensibly cancer-related symptoms.

Topics: Aeromonas hydrophila; Anti-Bacterial Agents; Ascites; Ascitic Fluid; Bacterial Infections; Drainage; Escherichia coli; Humans; Male; Middle Aged; Pancreatic Neoplasms; Peritonitis; Piperacillin, Tazobactam Drug Combination; Tomography, X-Ray Computed

Topics: Adenocarcinoma; Aged; Cefazolin; Cefepime; Diabetes Mellitus, Type 2; Drug Resistance, Microbial; Drug Resistance, Multiple, Bacterial; Flavobacteriaceae; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Kidney Failure, Chronic; Male; Pancreatic Neoplasms; Pancreatitis; Peritoneal Dialysis; Piperacillin, Tazobactam Drug Combination; Sleep Apnea Syndromes

Pancreaticoduodenectomy (PD) remains a morbid surgery. Preoperative biliary drainage (PBD) is often necessary before surgery but is associated with biliary contamination. We compared the postoperative complications of patients undergoing PBD who received the usual prophylactic antibiotics (PAs) or systematic antibiotherapy (ABT).. All patients who underwent surgery between 2008 and 2017 were included. Systematic perioperative ABT with piperacillin + tazobactam (ABT group) was implemented in 2014 as the standard of care for PBD. Patients treated in the period before such implementation, during which standard cefazolin was given, served as the controls (PAs group). The primary outcomes were postoperative complications.. We included 122 patients with PBD who underwent surgery. There were no demographic differences between the two groups. Perioperative ABT was associated with a reduction in deep abdominal abscesses (36% vs 10%, P = .0008), respiratory tract infections (15% vs 3%; P = .02), bacteremia (41% vs 6%; P < .0001), and a shorter length of hospital stay (17 [13-27] vs 13 [10-14] days; P < .0001). ABT was a protective factor against the development of deep abdominal abscesses (odds ratio [OR] = 0.16; P = .001) whereas smoking (OR = 3.9) and pancreatic fistula (OR = 19.1) were risk factors.. Systematic perioperative ABT in patients undergoing PD preceded by PBD may reduce deep surgical infections and the length of hospital stay.

Topics: Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Drainage; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pancreatic Neoplasms; Pancreaticoduodenectomy; Perioperative Care; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Preoperative Care; Prognosis; Surgical Wound Infection

Piperacillin-tazobactam was administered as a single dose (4.5 g intravenous) to five patients with stabilized external pancreatic fistula. The penetration into pancreatic juice was prompt, and inhibitory concentrations were achieved and maintained for different periods (0.5 to 6 h) according to bacterial susceptibility and patients' characteristics. Piperacillin and tazobactam showed superimposable pharmacokinetics in both serum and pancreatic juice.

Topics: Aged; Ampulla of Vater; Anti-Bacterial Agents; Bacterial Infections; beta-Lactamase Inhibitors; Common Bile Duct Neoplasms; Female; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreaticoduodenectomy; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination