Cefazolin Prophylaxis in Head and Neck Cancer Surgery

Becker, Gary D.; Parell, G. Joseph

doi:10.1177/000348947908800206

Cited by 117 publications

(72 citation statements)

References 8 publications

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“…According to international guidelines this prophylaxis is reported as able to control infective complications like pulmonary infections, wound infections, urinary tract infections and septic phlebitis. 7 …”

Section: Methodsmentioning

confidence: 99%

“…5,6 In the attempt to minimise PP onset patients eligible for partial laryngeal surgery are carefully pre-selected upon pulmonary and performance status, nevertheless PP remains the most important and feared complication even in this selected population, despite antibiotic prophylaxis. 7 The aim of this study is to review our experience with supracricoid and supraglottic laryngectomies at our Institution over a 20 years period in a series of 416 consecutive patients, to investigate possible PP risk factors. Since several reports from other districts 8,9 suggest a possible PP prognostic significance, we also investigated the prognostic role of PP in our series.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies

et al. 2009

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Summary The goal of this study was to identify host and tumour factors associated with postoperative pneumonia (PP) in a selected population of laryngeal cancer patients, treated by partial laryngectomy in 20 years at our Institution and to assess its potential prognostic impact. Clinical records of 416 consecutive patients were retrospectively reviewed. Tobacco consumption, body mass index (BMI), previous pulmonary disease, age, sex, preoperative blood gas analysis values, tumour stage and type of surgery were tested as potential risk factors for PP. Finally, the prognostic impact of these variables, including PP, in terms of disease-free and actuarial survival by Kaplan-Meier and Cox analyses were evaluated. PP developed in 73 patients (16.8%). We identified two groups of patients: 26 patients experienced an early PP within the first 7-9 days after surgery, whilst 44 experienced an ab ingestis PP following attempts of oral food intake restoration, three patients died for PP related sepsis. At multivariate Cox analysis, age older than 60 years and BMI greater than 30 were statistically associated with early PP; whereas male gender and laryngectomy with neck dissection were statistically related to a higher risk of ab ingestis PP. Interestingly, the occurrence of early PP was a negative independent prognostic factor for 5-years disease-free and actuarial survival (p = 0.049 and p = 0.001, respectively). The occurrence of early-onset pneumonia in laryngeal cancer patients selected for conservative laryngectomies is predictable and associated with poor clinical outcome.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies

et al. 2009

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“…These data suggest that: (1) Antibiotic prophylaxis reduced infection rates [12][13][14]; (2) beta-lactam antibiotics are appropriate first-line agents, with clindamycin reserved for patients with beta-lactam allergies [12][13][14][15][16][17][18][19]; and (3) prolonged courses of antibiotics do not generally result in greater reduction of infection rates. [5,[20][21][22].…”

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confidence: 99%

Antibiotic Use after Free Tissue Reconstruction of Head and Neck Defects: Short Course vs. Long Course

Khariwala

Pierce

et al. 2016

Surgical Infections

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Background: Free tissue reconstruction has become the standard of care for most major defects in the head and neck. Surgical site infection (SSI) can lead to vessel thrombosis and eventual flap loss. The use of antibiotics after free tissue reconstruction has not been studied in the current environment of heightened bacterial antibiotic resistance. We compared the use of short-term and longer-term antibiotics in a series of patients receiving free tissue reconstructions. Methods: A retrospective review was performed of 147 patients receiving 149 free flaps who were treated with either short-course (£2 d; n = 149 [43%]) or long-course (>2 d; n = 85 [57%])) post-operative antibiotics from 2009 to 2014. The outcomes examined were infection, return to the operating room, length of hospital stay, and patient death up to six weeks post-surgery. In addition, risk factors associated with SSI were explored. Results: Surgical site infection, flap dehiscence, flap loss, and length of stay were not different in the two groups. However, those receiving long-course antibiotics had a significantly higher rate of pneumonia (24.7% vs. 10.9%; p = 0.03), although they had a lower rate of urinary tract infection (0.0% vs 9.4%, respectively; p = 0.01). Body mass index remained a statistically significant risk factor in the multivariable analysis (p = 0.005). Conclusion: Prolonged antibiotic use after free flap reconstruction of head and neck defects does not appear to prevent SSI better than short-course treatment in this population. Moreover, long-course antibiotic use was associated with a higher risk of pneumonia.

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“…Without prophylaxis, the rate of wound infection ranges between 36 and 87% (2,4). Although numerous antimicrobial agents including synthetic penicillins, ureidopenicillins, clindamycin with or without an aminoglycoside, and various cephalosporins have been evaluated in this connection (5-8, 10, 11), there is no general agreement on the optimal regimen to recommend.…”

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confidence: 99%

Antimicrobial prophylaxis for major head and neck surgery in cancer patients

Gerard¹,

Meunier²,

Dor³

et al. 1988

Antimicrob Agents Chemother

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A total of 113 patients were randomly allocated to receive either ticarcillin plus clavulanic acid (total dose, 20.8 g) or clindamycin (total dose, 2.4 g) plus amikacin (total dose, 1 g) as perioperative antimicrobial prophylaxis for major head and neck surgery. The two groups were similar in age, prior antineoplastic treatment (surgery, chemotherapy, and radiotherapy) or tracheostomy, and the various types of surgery including radical neck dissection. The wound infection rate was 10% in the group of patients receiving clindamycin plus amikacin and 36% in the group receiving ticarcillin plus clavulanic acid (P < 0.05). Initiation of systemic antibiotic therapy within 15 days of surgery was necessary for 20 and 45% of these patients, respectively (P < 0.05). The distribution of microorganisms causing wound infections was comparable in both groups, except for anaerobes, which were isolated predominantly from patients who had received ticarcillin plus clavulanic acid.

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Cefazolin Prophylaxis in Head and Neck Cancer Surgery

Cited by 117 publications

References 8 publications

Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies

Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies

Antibiotic Use after Free Tissue Reconstruction of Head and Neck Defects: Short Course vs. Long Course

Antimicrobial prophylaxis for major head and neck surgery in cancer patients

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