Withholding Pre-emptive Antibiotics After Pancreaticoduodenectomy in Patients with Biliary Colonization: A Multicenter Propensity Score-Matched Cohort Study
Main finding · Overall survivalResult — go to the resultHR for mortality 2.02 95% CI 1.01–4.04Authors' conclusion
Withholding PE-ATB was not associated with worse early postoperative outcomes and was associated with reduced antibiotic exposure. The survival difference observed only after matching should be considered cautiously and may reflect residual confounding. Prospective randomized trials are needed.
Study context
- Population
- Adults undergoing pancreaticoduodenectomy with positive intraoperative bile cultures in four French tertiary centers between January 2014 and December 2024consecutive adults included, propensity score matching yielded 138 patients · received PE-ATB (overall) 89 · did not receive PE-ATB (overall) 212 · matched cohort 138
- Participants
- 301 adults
- Exposure
- Without PE-ATB vs PE-ATB
- PE-ATBn = 46reference
- Without PE-ATBn = 92
- Outcome
- Overall survival
- Follow-up
- 5 years
Methodological detailsPropensity score matching at a 1:2 ratio, consecutive adults, prespecified exploratory non-inferiority margins
- Propensity score matching at a 1:2 ratio
- Consecutive adults
- Prespecified exploratory non-inferiority margins
Main finding
As reported in the abstract
HR for mortality
2.02
95% CI 1.01–4.04
P = 0.048
Without PE-ATB vs PE-ATB
HR for mortality 2.02 (95% CI 1.01–4.04); P = 0.048
Observational data: associations, not effects.
Further findings
Predictor of PE-ATB use: preoperative biliary stenting
| Odds ratio (95% CI) | P value | ||
|---|---|---|---|
| Preoperative biliary stentingIndependently predicted PE-ATB use | 4.11 (1.26–13.40) | P = 0.019 | |
| 0.050.21520Odds ratio (log scale) |
Overall postoperative infection
| Odds ratio (95% CI) | P value | ||
|---|---|---|---|
| Overall postoperative infection | 1.42 (0.66–3.07) | P = 0.376 | |
| 0.20.5125Odds ratio (log scale) |
- Overall postoperative infection: did not differ significantly between groups; order of groups not stated
Intra-abdominal abscess, pancreatic fistula, transfusion requirements, and antibiotic duration
- Withholding PE-ATB was compatible with the non-inferiority margin
- Matched cohort
- Prespecified exploratory non-inferiority margins
Original publication
Withholding Pre-emptive Antibiotics After Pancreaticoduodenectomy in Patients with Biliary Colonization: A Multicenter Propensity Score-Matched Cohort Study. Anaesth Crit Care Pain Med. Published 21 October 2026. doi:10.
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