{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:01:52Z","timestamp":1784307712726,"version":"3.55.0"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T00:00:00Z","timestamp":1734307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Biliary contamination significantly correlates with major comorbidities during pancreatic head resection. Recently, a piperacillin\u2010tazobactam prophylaxis demonstrated a lower rate of infectious complications (IC) and postoperative pancreatic fistula (POPF) in this population. However, bacterial contamination is rare in patients without a preoperative biliary drainage (PBD) and probably could not benefit from this antibiotic. Furthermore, little is known about the role of biliary fungal contamination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>All retrospective cases undergoing pancreatic head resection with intraoperative biliary sample were included. Postoperative outcomes of patients with a piperacillin\u2010tazobactam\u2010based treatment were compared to cases in which a narrow\u2010spectrum antibiotic was administrated, stratified according to the use of a PBD. The same analysis was repeated for antifungal treatment administration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 205 cases included, PBD was necessary in 127 patients (62%). Broad\u2010spectrum treatment was associated with fewer overall and clinically relevant POPF (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.001 and <jats:italic>p<\/jats:italic>\u00a0=\u00a00.004), overall morbidity (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.044), and overall IC (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.018), but only in the PBD group. Similarly, antifungal treatment was significantly associated with some specific IC only in the PBD group. At multivariable analysis, antifungal therapy in the whole cohort (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.029) and the use of a piperacillin\u2010tazobactam (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.007) treatment in patients with a PBD were independently associated with a reduced risk of a clinically relevant POPF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A broad\u2010spectrum antibiotic therapy reduces overall morbidity after pancreatic head resection, but only in cases with a history of PBD. Furthermore, the use of an antifungal prophylaxis or therapy should be further investigated in these patients because it may reduce the risk of some IC.<\/jats:p><\/jats:sec>","DOI":"10.1002\/wjs.12446","type":"journal-article","created":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T23:24:44Z","timestamp":1734391484000},"page":"270-282","source":"Crossref","is-referenced-by-count":5,"title":["Adaptation of antibiotics and antifungal strategy to preoperative biliary drainage to improve postoperative outcomes after pancreatic head resection"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5065-6962","authenticated-orcid":false,"given":"Fabio","family":"Giannone","sequence":"first","affiliation":[{"name":"Department of Visceral and Digestive Surgery University Hospital of Strasbourg  Strasbourg France"},{"name":"Inserm Institut de Recherche sur Les Maladies Virales et H\u00e9patiques U1110 Strasbourg University  Strasbourg France"},{"name":"Hepato\u2010Pancreato\u2010Biliary, Oncologic and Robotic Unit Azienda Ospedaliero\u2010Universitaria SS. 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