What does this research mean for the field?

There is significant global variation in antibiotic prophylaxis practices among surgeons performing pancreatoduodenectomy, indicating a lack of consensus on optimal protocols. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

March 13, 2026Open Access

Global Practices in Antibiotic Prophylaxis for Pancreatoduodenectomy: Insights from an International Survey among HPB Surgeons

Key Points

This survey aims to evaluate global practices in antibiotic prophylaxis for pancreatoduodenectomy and identify variations among surgeons.
Conducted an online survey among international surgical associations from April to September 2024.
Collected responses from 215 surgeons focusing on intraoperative and prolonged antibiotic practices.
Analyzed responses descriptively and compared practices across continents and surgical center volumes.
Piperacillin-tazobactam is the most commonly used intraoperative antibiotic (44%).
Usage varies by continent: North America (68%), Europe (29%), Asia (22%).
Prolonged prophylaxis is always used by 13% of surgeons and selectively by 66%, based on indications like infection signs or biliary drainage.
47% prefer piperacillin-tazobactam for prolonged prophylaxis, typically for five days.
Bile cultures are obtained routinely by 47%, with 22% adjusting prophylaxis based on culture results.

Abstract

AbstractBackground Optimizing antibiotic prophylaxis might improve outcomes after pancreatoduodenectomy. Current guidelines lack clear recommendations regarding the type and duration of prophylaxis. This survey evaluated global practices for antibiotic prophylaxis in pancreatoduodenectomy. Methods An online survey among the members of international surgical associations was distributed from April to September 2024. Sixteen questions addressed intraoperative and prolonged antibiotic prophylaxis practices. Responses were analyzed descriptively and compared across continents and center volumes. Results A total of 215 surgeons participated. Piperacillin-tazobactam was the most commonly used intraoperative antibiotic (44%), with variations across continents (North America: 68%, Europe: 29%, Asia: 22%). Prolonged prophylaxis was always used by 13% and selectively used by 66% of the surgeons with indications being mainly perioperative signs of infection (45%) or preoperative biliary drainage (55%). Piperacillin-tazobactam was preferred as prolonged prophylaxis (47%), mostly during five days (25%). Bile cultures were routinely obtained by 47% of the surgeons. Antibiotic prophylaxis was routinely adjusted based on bile culture results by 22% of the surgeons. Conclusion Global variations in perioperative antibiotic practices indicate a lack of consensus regarding antibiotic prophylaxis for pancreatoduodenectomy. Further research is required to clarify the effect of targeted antibiotic prophylaxis for patients with contaminated bile, while preserving antibiotic stewardship.

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Cite This Study

Droogh et al. (Sun,) studied this question.

synapsesocial.com/papers/69b3ab0002a1e69014ccba74 https://doi.org/https://doi.org/10.1016/j.hpb.2026.02.009

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