Prospective comparison of perioperative antibiotic management protocols in oncological head and neck surgery

Bartella, Alexander K.; Kamal, Mohammad Amjad; Teichmann, Jan; Kloss‐Brandstätter, Anita; Steiner, Timm; Hölzle, Frank; Lethaus, Bernd

doi:10.1016/j.jcms.2017.04.001

Cited by 30 publications

(40 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In SSIs despite clindamycin prophylaxis, gram-negative bacteria are often isolated, i.e., their coverage is insufficient. This finding is consistent with multiple RCTs concluding that clindamycin ABP carries an increased SSI rate [5,8,10,19,23,27,38,43] and a higher risk of antibiotic-related complications, such as Pseudomonas, MRSA, and C. difficile infections including pseudomembranous colitis [6,10]. Contrary to this finding, and like many other guidelines [12], the Leuven University Hospitals' guidelines still recommend clindamycin as an alternative for penicillin-allergic patients [11], because there are only few studies studying alternative agents in patients with a true penicillin allergy.…”

Section: Discussionsupporting

confidence: 90%

“…Sepehr et al [22], comparing cefazolin-metronidazole for less or more than 5 days, showed the same SSI rate in both groups (p = 0.06). In contrast, Bartella et al [6] randomized 75 patients to receive ampicillin-sulbactam and clindamycin in case of penicillin allergy for more or less than 5 days. Initially they found significantly less SSIs when ABP was prolonged until the 5th postoperative day (p = 0.013).…”

Section: Duration Of Postoperative Antibiotic Coursementioning

confidence: 99%

“…The UADT harbors a large variety of microorganisms, such as gram-positive and facultative anaerobic bacteria, and to a lesser degree gram-negative bacteria, Candida species, and bacteria originating from an eventually harvested flap [4]. When patients with a compromised condition, undergoing extensive procedures (with a prolonged operation time and use of foreign bodies such as tracheal cannulas), are exposed to this flora, they experience a higher incidence of SSIs [5,6]. In the absence of antibiotic prophylaxis, SSI rate ranges between 24% and 87% in this patient group [7].…”

Section: Introductionmentioning

confidence: 99%

“…While judicious use of antibiotics reduces the postoperative infection rate, inappropriate use can cause unwanted effects such as rash (0.3-2.1%), acute renal failure, pneumonia, Clostridium difficile infections (5%), pseudomembranous colitis (10% for clindamycin), and the development of antibiotic resistance [5,6,10].…”

Section: Introductionmentioning

confidence: 99%

“…The duration of prophylaxis ranges from 1 day to more than 5 days. The CDC states that up to 50% of all administered antibiotics are inappropriate or unnecessary [6].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

Background: The optimal evidence-based prophylactic antibiotic regimen for surgical site infections following major head and neck surgery remains a matter of debate. Methods: Medline, Cochrane, and Embase were searched for the current best evidence. Retrieved manuscripts were screened according to the PRISMA guidelines. Included studies dealt with patients over 18 years of age that underwent clean-contaminated head and neck surgery (P) and compared the effect of an intervention, perioperative administration of different antibiotic regimens for a variable duration (I), with control groups receiving placebo, another antibiotic regimen, or the same antibiotic for a different postoperative duration (C), on surgical site infection rate as primary outcome (O) (PICO model). A systematic review was performed, and a selected group of trials investigating a similar research question was subjected to a random-effects model metaanalysis.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Duration Of Postoperative Antibiotic Coursementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The duration of prophylaxis ranges from 1 day to more than 5 days. The CDC states that up to 50% of all administered antibiotics are inappropriate or unnecessary [6].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

Evaluation of Prolonged vs Short Courses of Antibiotic Prophylaxis Following Ear, Nose, Throat, and Oral and Maxillofacial Surgery

Oppelaar

Zijtveld

Kuipers

et al. 2019

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

IMPORTANCE Antibiotic prophylaxis is widely used after surgical procedures operating on the mucosal tissues of the aerodigestive tract, but the optimal duration of these prophylactic therapies is often unclear. OBJECTIVE To compare short-course antibiotic prophylaxis (Յ24 hours) vs extended-course antibiotic prophylaxis (Ն72 hours) after ear, nose, throat, and oral and maxillofacial surgery. DATA SOURCES AND STUDY SELECTION Literature searches of PubMed were completed in October 2017 and included prospective trials that compared antibiotic prophylaxis courses of 24 hours or less vs 72 hours or more after ear, nose, throat, and oral and maxillofacial surgery. Some studies were also handpicked from reference lists of studies found with the initial search terms. All analysis was performed between September 2017 and October 2018. DATA EXTRACTION AND SYNTHESIS All review stages were conducted in consensus by 2 reviewers. Data extraction and study quality assessment were performed with the Cochrane data extraction form and the Cochrane risk of bias tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting. The fixed-effects Mantel-Haenszel method was used for meta-analysis. MAIN OUTCOMES AND MEASURES Relative risk (RR) of surgical site infections, microbial origins of surgical site infections, adverse events, duration of hospital stay, and treatment costs. RESULTS Included in the meta-analysis were 21 articles with a cumulative 1974 patients. In patients receiving 24 hours or shorter vs 72 hours or longer antibiotic prophylaxis regimens, no significant difference was found in the occurrence of postoperative infections in the pooled population (RR, 0.90; 95% CI, 0.67-1.19), or in the ear, nose, throat (RR, 0.89; 95% CI, 0.54-1.45), and oral and maxillofacial populations (RR, 0.88; 95% CI, 0.63-1.21), separately. No heterogeneity was observed overall or in the subgroups. Patients receiving extended-course antibiotic prophylaxis were significantly more likely to develop adverse events unrelated to the surgical site (RR, 2.40; 95% CI, 1.20-3.54). CONCLUSIONS AND RELEVANCE No difference was found in the occurrence of postoperative infections between short-course and extended-course antibiotic prophylaxis after ear, nose, throat, and oral and maxillofacial surgery. Therefore, a short course of antibiotic prophylaxis is recommended unless documented conditions are present that would be best treated with an extended course. Using short-course antibiotics could avoid additional adverse events, antibiotic resistance development, and higher hospital costs. Future research should focus on identifying risk groups that might benefit from prolonged prophylaxis.

show abstract

Risk factors for surgical site infection in free‐flap reconstructive surgery for head and neck cancer: Retrospective Australian cohort study

et al. 2021

View full text Add to dashboard Cite

Background: Surgical site infections (SSI) are common complications of free-flap reconstruction for head and neck cancer defects. This study aimed to identify risk factors for SSI following a significant change in local antibiotic prophylaxis practice. Methods: A retrospective cohort study was conducted of 325 patients receiving free-flap reconstruction for head and neck cancer defects at a tertiary hospital in Melbourne, Australia between 2013 and 2019. Charts were queried for recipient SSI (primary outcome), donor SSI, other infections, antibiotic use, hospital length of stay, and mortality.Results: Risk factors for SSI included female sex, T-classification, hardware insertion, clindamycin prophylaxis, and operative duration. There was a trend toward increased SSI with shorter ≤24 h prophylaxis (OR: 0.43). Conclusion:Antibiotic duration and type were associated with SSI. Complexity of surgery, T-classification, hardware use, and operative duration were also independently associated with SSI. A prospective trial is indicated to elicit optimal prophylactic antibiotic duration.

show abstract

Prospective comparison of perioperative antibiotic management protocols in oncological head and neck surgery

Cited by 30 publications

References 19 publications

Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis

Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis

Evaluation of Prolonged vs Short Courses of Antibiotic Prophylaxis Following Ear, Nose, Throat, and Oral and Maxillofacial Surgery

Risk factors for surgical site infection in free‐flap reconstructive surgery for head and neck cancer: Retrospective Australian cohort study

Contact Info

Product

Resources

About