Surgical prophylaxis with gram‐negative activity for reduction of surgical site infections after microvascular reconstruction for head and neck cancer

Abstract

Alcohol use, longer surgical duration, and lack of gram-negative postoperative prophylactic coverage are modifiable risk factors for surgical site infection development. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1454, 2016.

Multicenter Assessment of Antibiotic Prophylaxis Spectrum on Surgical Infections in Head and Neck Cancer Microvascular Reconstruction

“…28 The investigators found a lower incidence of SSI among patients who received ampicillin/sulbactam versus clindamycin (13% vs 27%, P = .02). While these findings were demonstrated in a number of additional studies, 4,19,29 some investigators found no difference in SSI when using GN POABP and not. [30][31][32][33][34][35][36] Many of these data focus on clindamycin POABP as a significant risk factor for SSI, suggesting that GN coverage leads to better patient outcomes.…”

“…[1][2][3] SSIs in this setting are associated with poor outcomes, including prolonged hospitalizations, development of additional health care-associated infections, and death. [2][3][4] While advancements in head and neck reconstruction have continued to develop, there remain few data identifying modifiable risk factors for SSI prevention. [5][6][7][8][9][10] Antibiotic prophylaxis has reduced the incidence of SSI in patients who have undergone extensive surgical revision of the head and neck, [11][12][13][14] but current surgical infection prophylaxis guideline recommendations may fail to account for the complexity of microvascular reconstruction relative to other head and neck procedures regarding spectrum and duration.…”

“…15,[19][20][21] Despite limited data surrounding the causative organisms of head and neck SSI in the oncology population, broad-or extended-spectrum antibiotic prophylaxis is routinely prescribed. 4,6,22 Strategies to prevent antimicrobial overuse, a key component of antimicrobial stewardship, include using the narrowest spectrum and shortest duration of antimicrobials needed to prevent infection. 23,24 Additionally, optimal POABP durations in this setting are unknown and, when combined with overuse of extended-spectrum antimicrobials, can lead to poor outcomes (eg, SSI), selection for resistant organisms, or severe adverse reactions (eg, Clostridium difficile-associated diarrhea).…”

Systematic review of international guidelines for perioperative antibiotic prophylaxis in Head & Neck Surgery. A YO‐IFOS Head & Neck Study Group Position Paper

“…Available data related to the use of extended spectrum prophylaxis targeted to multidrug resistant pathogens, such as multidrug resistant S aureus (MRSA) and P aeruginosa , are limited. Both organisms are listed as CDC major health threats and have the capability to colonize the skin, respiratory tract, and prosthetic material used for surgical revision or infusion of IV chemotherapy agents (eg, tracheostomy or indwelling central venous catheters) . Although the incidence of these organisms in SSI is questionable or underreported, the perceived risk and detrimental effects these organisms have on patient outcomes contribute to antibiotic misuse by clinicians …”

Literature Review of Criteria for Defining Recipient-Site Infection after Oral Oncologic Surgery with Simultaneous Reconstruction

“…The application criteria in the study by Pool et al [17] were similar to the diagnostic criteria of deep incisional SSI. In only one study by Wagner et al [18], SSIs were classified as superficial or deep. Notably, in three studies, orocutaneous fistula that did not meet the CDC criteria was not categorized as a SSI [3,17,19].…”