An Antibiotic Stewardship Program in Pancreatic Surgery

作者：Matteo De Pastena, Salvatore Paiella, Erica Secchettin, Damiano Caputo, Luca Moraldi, Danila Azzolina, Laura Addari, Elena Carrara, Anna Maria Azzini, Luca Tirloni, Roberto Coppola, Ilenia Bartolini, Vincenzo La Vaccara, Matteo Risaliti, Roberto Cammarata, Irene Urciuoli, Tommaso Giani, Alessandro Esposito, Luca Casetti, Luca Landoni, Antonio Pea, Martina Fontana, Giuseppe Malleo, Annarita Mazzariol, Dario Gregori, Silvia Angeletti, Massimo Ciccozzi, Carlotta Fiammenghi, Evelina Tacconelli, Roberto Salvia · 发表于：JAMA Network Open · 年份：2025 · DOI：10.1001/jamanetworkopen.2025.20149 · 被引用次数：5 · 研究领域：Pancreatic and Hepatic Oncology Research、Surgical site infection prevention、Amoebic Infections and Treatments

Importance: Antimicrobial stewardship (AMS) programs optimize antibiotic use and mitigate antimicrobial resistance. The literature on the efficacy of AMS programs in pancreatic surgery is limited. Objective: To investigate the association of a multifaceted AMS intervention targeting surgical antibiotic prophylaxis (SAP) with the rate of surgical site infections (SSIs) following pancreatic surgery. Design, Setting, and Participants: This cross-sectional study was a multicenter, before-and-after analysis conducted at 3 Italian centers. The intervention cohort included adult patients aged 18 years or older who underwent pancreatectomy between January 1, 2020, and December 31, 2022, while the historical cohort included patients from January 1, 2015, to December 31, 2019. Exposure: A multiprofessional, multidimensional ASM program that included a bundle of interventions and pivoted on preoperative rectal screening for multidrug-resistant bacteria and targeted SAP. Main Outcomes and Measures: The primary outcomes were SSI incidence and SAP appropriateness, assessed through the coverage rate of rectal and biliary isolates. Data were analyzed using propensity score weighting. Secondary outcomes evaluated were other postoperative outcomes (eg, pancreatic fistula rate, length of stay), antibiotic use, and costs. Results: A total of 3387 patients (median [IQR] age, 66 [66-73] years; 1788 male [52.8%]) were included, with 1219 in the intervention cohort and 2168 in the historical cohort....