Does Cefoxitin or Piperacillin-Tazobactam Prevent Postoperative Surgical Site Infections After Pancreatoduodenectomy?

A Phase III Multicenter, Open Label Randomized Controlled Trial of Cefoxitin Versus Piperacillin-Tazobactam as Surgical Antibiotic Prophylaxis in Patients Undergoing Pancreatoduodenectomy

The purpose of this study is to figure out which commonly used antibiotic, cefoxitin or piperacillin-tazobactam, is better at decreasing the rate of surgical site infections after pancreatoduodenectomy.

Inclusion Criteria:

• Age >/= 18 years
• Patients undergoing elective pancreatoduodenectomy (PD) for any diagnosis/indication

Exclusion Criteria:

• Patients undergoing a minimally invasive PD, such as laparoscopic or robotic PD
• Patients with known and documented allergies to any of the penicillins, cephalosporins, or β-lactamase inhibitors
• Patients who are otherwise ineligible to receive the antibiotics in this study
• Patients highly unlikely to undergo PD according to the surgeon's judgment, such as conditions amenable to pancreas enucleation, ampullectomy, etc.
• Patients with long-term glucocorticosteroid use. The following uses of corticosteroids are permitted: single doses, topical applications (e.g., for rash), inhaled sprays (e.g., for obstructive airways diseases), eye drops or local injections (e.g., intra-articular)
• Patients unable to provide informed consent
• Creatinine clearance (CrCl) </= 40 mL/min
• Patients receiving hemodialysis or peritoneal dialysis
• Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test
• Patients with a known bacterial infection present at the time of surgery or who received antimicrobial therapy within 7 days prior to surgery