{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T07:02:21Z","timestamp":1779951741701,"version":"3.53.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the compliance with antibiotic prophylaxis (AP) guidelines after pancreatic surgery, identify predictors of extended AP usage (&amp;gt;24\u202fh), and assess the association between extended AP and surgical site infection (SSI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort study was conducted involving 1,073 patients who underwent pancreatic surgery at the First Affiliated Hospital with Nanjing Medical University between January and December 2022. Based on the strict intent-of-use definition in the electronic medical record, patients were categorized into the AP\u202f&amp;gt;\u202f24\u202fh group (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f135) and the Non-AP\u202f&amp;gt;\u202f24\u202fh group (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f938). Univariate and multivariate logistic regression analyses were performed to identify factors associated with AP\u202f&amp;gt;\u202f24\u202fh. Additionally, a hierarchical modeling approach was employed to evaluate the independent association between extended AP and the risk of SSI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 1,073 patients, 12.58% (135\/1,073) received AP\u202f&amp;gt;\u202f24\u202fh. The cumulative days of postoperative AP ranged from 1 to 24, with a mean of 6.24\u202f\u00b1\u202f4.09\u202fdays. While 93.20% of surgeries were performed in specialized pancreatic centers, 6.80% were performed in non-pancreatic centers. Multivariate analysis identified that surgery performed in non-pancreatic centers was an independent predictor associated with AP\u202f&amp;gt;\u202f24\u202fh (OR\u202f=\u202f2.61, 95%CI\u202f=\u202f1.04\u20136.54;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.041). Crucially, in the fully adjusted model, extending AP beyond 24\u202fh was not associated with a lower risk of SSI (OR\u202f=\u202f1.67, 95% CI: 0.997\u20132.79;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.053).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A substantial gap between guidelines and clinical practice persists, with 12.58% of patients receiving extended AP. Surgery performed in non-pancreatic centers was identified as a significant predictor for non-adherence, with the odds of extended use being 2.61 times that of specialized centers. Given that prolonged AP was not associated with reduced SSI rates, targeted stewardship interventions are urgently needed to standardize protocols, particularly in non-specialized departments, to avoid unnecessary antibiotic exposure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1727898","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T06:15:24Z","timestamp":1779948924000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Extended antibiotic prophylaxis beyond 24\u202fh after pancreatic surgery: prevalence and risk factors"],"prefix":"10.3389","volume":"14","author":[{"given":"Zhanjie","family":"Li","sequence":"first","affiliation":[{"name":"Department of Infection Control, The First Affiliated Hospital with Nanjing Medical University","place":["Nanjing, Jiangsu, China"]},{"name":"Department of Epidemiology and Health Statistics, School of Public Health, Fudan University","place":["Shanghai, China"]},{"name":"Institute of Hospital Reform and Development of China, Nanjing University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital with Nanjing Medical University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanlong","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, The First Affiliated Hospital with Nanjing Medical University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoju","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Hospital Acquired Infection Control and Public Health Management, The Seventh Affiliated Hospital, Sun Yat-sen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1186\/s13756-018-0424-z","article-title":"Optimal timing of surgical antimicrobial prophylaxis in laparoscopic surgery: a before-after study","volume":"7","author":"Takamatsu","year":"2018","journal-title":"Antimicrob Resist Infect Control"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e048398","DOI":"10.1136\/bmjopen-2020-048398","article-title":"Cefoxitin versus piperacillin\u2013tazobactam as surgical antibiotic prophylaxis in patients undergoing pancreatoduodenectomy: protocol for a randomised controlled trial","volume":"11","author":"Nevarez","year":"2021","journal-title":"BMJ Open"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2826","DOI":"10.21037\/jtd.2017.08.81","article-title":"Antimicrobial prophylaxis is critical for preventing surgical 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