Decision for Termination of Prophylactic Antimicrobials Administration in Pancreatoduodenectomy -SIRS-based Simplified Criteria-

Yasuki Unemura, Shuichi Fujioka, Yoshiaki Tanabe, Katsumaro Suzuki, Takeyuki Misawa, Tetsuji Fujita, Susumu Kobayashi, Yoji Yamazaki

Department of Surgery, The Jikei University School of Medicine

In order to determine the time to terminate or change administration of prophylactic antimicrobials in the perioperative period of pancreatoduodenectomy, the simplifed method to assess the postoperative status according to the criteria for SIRS was used. In 38 patients who received pancreatoduodenectomy during the past five years, a postoperative infectious complication occurred in 42%. Prophylactic antimicrobial administration failed in 16%, so that early infectious complication occurred. the pathogenic microorganisms were resistant to the drug administered, with an ineffective outcome. The positive rate according to the SIRS-based criteria on POD 3, 4 and 5 was 32, 18 and 23%, and 25, 60 and 63% of the patients had early infectious complications. The criteria-posivive status was the result of surgical stress or atelectasis in most patients on POD 3 or 4. In patients who were criteria-nagative status on POD 5, early infectious complications didn't occurred in 96%, the accuracy of the criteria was as high as 0.89. Therefore, if the result was negative on POD 5, an early infectious complication was considered to have been prevented, indicating that prophylactic antimicrobial administration should be terminated at this time. However, if the result remains positive, switching to another drug would be appropriate, assuming the occurrence of infection.

Key words
pancreatoduodenectomy, systemic inflammatory response syndrome, surgical infection, antibiotics, prediction of postoperative infection

Reprint requests
Yasuki Unemura Department of Surgery, The Jikei University School of Medicine
3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461 JAPAN

Accepted
January 14, 1998

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