title: Perioperative antibiotics for surgical site infection in pancreaticoduodenectomy: does the SCIP-approved regimen provide adequate coverage?
abstract: BACKGROUND
  The Joint Commission Surgical Care Improvement Project (SCIP) includes performance measures aimed at reducing surgical site infections (SSI). One measure defines approved perioperative antibiotics for general operative procedures. However, there may be a subset of procedures not adequately covered with the use of approved antibiotics. We hypothesized that piperacillin-tazobactam is a more appropriate perioperative antibiotic for pancreaticoduodenectomy (PD).
  
  
  METHODS
  In collaboration with hospital epidemiology and the Division of Infectious Diseases, we retrospectively reviewed records of 34 patients undergoing PD between March and May 2008 who received SCIP-approved perioperative antibiotics and calculated the SSI rate. After changing our perioperative antibiotic to piperacillin-tazobactam, we prospectively reviewed PDs performed between June 2008 and March 2009 and compared the SSI rates before and after the change.
  
  
  RESULTS
  For 34 patients from March through May 2008, the SSI rate for PD was 32.4 per 100 cases. Common organisms from wound cultures were Enterobacter and Enterococcus (50.0% and 41.7%, respectively), and these were cefoxitin resistant. From June 2008 through March 2009, 106 PDs were performed. During this period, the SSI rate was 6.6 per 100 surgeries, 80% lower than during March through May 2008 (relative risk, 0.204; 95% confidence interval [CI], 0.086-0.485; P = .0004).
  
  
  CONCLUSIONS
  Use of piperacillin-tazobactam as a perioperative antibiotic in PD may reduce SSI compared with the use of SCIP-approved antibiotics. Continued evaluation of SCIP performance measures in relationship to patient outcomes is integral to sustained quality improvement.
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-6904, USA. grahamwdonald@gmail.com
authors.forename: Graham W
authors.initials: GW
authors.lastname: Donald
authors.forename: Dharma
authors.initials: D
authors.lastname: Sunjaya
authors.forename: Xuyang
authors.initials: X
authors.lastname: Lu
authors.forename: Formosa
authors.initials: F
authors.lastname: Chen
authors.forename: Barbara
authors.initials: B
authors.lastname: Clerkin
authors.forename: Guido
authors.initials: G
authors.lastname: Eibl
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.forename: James S
authors.initials: JS
authors.lastname: Tomlinson
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Donahue
authors.forename: Howard A
authors.initials: HA
authors.lastname: Reber
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Hines
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D012709:Serum Albumin; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin