This study aimed to investigate the incidence of postoperative pneumonia (PP) and surgical site infection (SSI) in head and neck cancer (HNC) patients and clarify the relationship between oral care and postoperative infection. Methods: We conducted a retrospective observation survey based on the medical records of 209 HNC surgery patients managed at a University Hospital in 2016-2018. The incidence of PP and SSI were assessed in patients who underwent operations of the nose and paranasal sinuses to the larynx. Factors associated with PP and SSI in a univariate analysis were included in a multiple logistic regression analysis. A Cox proportional hazards model was used analyze the incidence of PP according to time after surgery. The present study was approved by the ethical review board of our Institute. Results: The rates of PP and SSI in our study population were 20.5% and 23.0%. Operative time (P < 0.01), blood loss (P = 0.004), tracheostomy (P < 0.01), reconstruction (P < 0.01), and preoperative plaque control record (PCR) (P < 0.01) were significantly associated with PP. The PCR depicted the oral hygiene based on the percentage of plaque attached to the tooth neck. A multiple logistic regression analysis indicated that the incidence of PP was significantly higher in patients with PCR values of ≥50% after preoperative oral care (OR = 10.174, 95% CI 2.14-48.32, P = 0.004). Tracheostomy (P < 0.01), reconstruction (P = 0.044), a lower preoperative albumin level (P = 0.019), and a lower preoperative hemoglobin level (P < 0.01) were significantly associated with SSI. Conclusions: The incidence of PP among patients who received oral care was high in those patients with high PCR values, indicating the importance of increasing compliance to preoperative oral care.

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Stenotrophomonas maltophilia is an important pathogen in immunocompromised patients, such as patients with malignancies, long-term hospitalized patients, or patients receiving broad-spectrum antibiotic therapy. We conˆrmed an outbreak of S. maltophilia in allogenic bone marrow transplant patients in June 2007. To identify the source of the pathogens, environmental cultures were obtained from the transplantation unit. S. maltophilia strains were isolated from a bath chair, a shower head, and an automatic hot towel dispenser. Outbreak-related strains from 4 patients and 4 strains from the environment were compared by pulsed-ˆeld gel electrophoresis (PFGE). Two strains from blood cultures and one strain from the dispenser were identical, as conˆrmed by PFGE, which showed that the outbreak was associated with the automatic hot towel dispenser. Subsequently, many types of non-fermentative Gram-negative organisms were isolated from all automatic hot towel dispensers placed in other wards. These results indicate that medical equipment containing water requires careful attention to maintain sterility in use. Key wordsautomatic hot towel dispenser, Stenotrophomonas maltophilia, outbreak, pulsed-ˆeld gel electrophoresis (PFGE), neutropenia