317 Policy, Practice and Prophylaxis: Local Microbial Ecology and Surgical Site Infections After Pancreaticoduodenectomy

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Abstract Aim Evidence increasingly supports the use of piperacillin–tazobactam (TZP) for prophylaxis in pancreaticoduodenectomy (PD). This study aims to characterise prescribing, microbiology, and resistance patterns to guide policy change in a UK unit. Method Forty-four PDs were grouped by antibiotic prophylaxis and surgical-site infection (SSI). ISGPS post-operative pancreatic fistula (POPF) grade was recorded prospectively. Routinely cultured samples (bile, stent), infection-driven cultures (drain, wound, blood) and susceptibilities were retrospectively reviewed. Results Superficial and organ-space SSI occurred in 8/44 (18%) and 17/44 (38%) patients. Organ-space SSI rates within each prophylaxis group were: TZP 4/11 (36%), Cefuroxime+Metronidazole 9/22 (41%), Co-amoxiclav 4/6 (67%), Teicoplanin/Ciprofloxacin/Metronidazole 0/5 (0%). POPF B/C rates showed a similar pattern (27%, 32%, 33%, 0%). Biliary stenting was not associated with higher rates of SSI. Routine (35 organisms; 20 patients) and infection cultures (43 organisms; 23 patients) were dominated by Enterobacterales; enterococci accounted for 20 % of isolates, and Staphylococcus aureus, anaerobes and yeasts each account for 5-10% of all cultures, whereas Pseudomonas was less frequent (3%). When both routine and infection samples were taken, organism concordance was 8/8. Only 13 infection isolates had susceptibility panels: 3/4 TZP-tested isolates were resistant (all in stented patients), while one resistant isolate was seen across cefuroxime, co-amoxiclav and teicoplanin. Conclusions Single-agent TZP may under-treat the reported spectrum of local flora. Multi-agent prophylaxis, especially in patients with biliary stents, should be considered in future policy and be supported by rapid reporting of routine bile/stent cultures. The optimal duration of antibiotics remains unclear and requires further research.

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