Antibiotic Stewardship Program in Pancreatic Surgery: a Multicenter Time Series Analysis (BIOSTEPS).

A multicenter time series with segmented regression analysis will be conducted at three national high-volume centers of pancreatic surgery: The General and Pancreatic Surgery Department, Pancreas Institute, of Verona, the Oncological and Robotic General Surgery, Careggi University of Florence, and the Department of Surgery, University Campus Bio-Medico of Rome. All patients visited at the General and Pancreatic Surgery Department, Pancreas Institute, of Verona, the Oncological and Robotic General Surgery, Careggi Hospital, University of Florence, and the Department of Surgery, University Campus Bio-Medico of Rome and scheduled for pancreatic resection will be enrolled. The patients will be submitted to the routinely diagnostic preoperative procedures, including the RS culture, two weeks before surgery. All patients enrolled will receive a preoperative clinical visit two weeks before surgery. During the patient's interview, the surgeon will collect the medical history, exposing the clinical and surgical perioperative pathways. The patient is also submitted to the routinely preoperative lab tests, including the RS. The study design is based on evidence collected by previous studies of the group and after a systematic review of the literature. The ASP has been shown to effectively reduce unnecessary antibiotic use and optimize the treatment of infectious diseases. To be successful, multiple aspects should be considered in the ASP. Initially, the infection control specialists will follow the routine activity of each department in order to define what could immediately be improved. Internal antibiotic prophylaxis and therapy guidelines will be defined and shared between groups. The RS, collected at the preoperative testing, is evaluated by the infection control specialist. In case of identification of MDR bacteria, each patient will receive a tailored AP based on the antibiograms of the RS. In any case, the infection control specialist will choose the best solution for the patient avoiding the key antibiotics.