Surgical Site Infections in Patients Receiving Osteomyocutaneous Free Flaps to the Head and Neck. Does Choice of Antibiotic Prophylaxis Matter?

Murphy, James; Isaiah, Amal; Dyalram, Donita; Lubek, Joshua E.

doi:10.1016/j.joms.2017.02.006

Cited by 41 publications

(34 citation statements)

References 28 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Veve

Greene

Williams

et al. 2018

Otolaryngol.--head neck surg.

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Objective To characterize and identify risk factors for 30-day surgical site infections (SSIs) in patients with head and neck cancer who underwent microvascular reconstruction. Study Design Cross-sectional study with nested case-control design. Setting Nine American tertiary care centers. Subjects and Methods Hospitalized patients were included if they underwent head and neck cancer microvascular reconstruction from January 2003 to March 2016. Cases were defined as patients who developed 30-day SSI; controls were patients without SSI at 30 days. Postoperative antibiotic prophylaxis (POABP) regimens were categorized by Gram-negative (GN) spectrum: no GN coverage, enteric GN coverage, and enteric with antipseudomonal GN coverage. All POABP regimens retained activity against anaerobes and Gram-positive bacteria. Thirty-day prevalence of and risk factors for SSI were evaluated. Results A total of 1307 patients were included. Thirty-day SSI occurred in 189 (15%) patients; median time to SSI was 11.5 days (interquartile range, 7-17). Organisms were isolated in 59% of SSI; methicillin-resistant Staphylococcus aureus (6%) and Pseudomonas aeruginosa (9%) were uncommon. A total of 1003 (77%) patients had POABP data: no GN (17%), enteric GN (52%), and antipseudomonal GN (31%). Variables independently associated with 30-day SSI were as follows: female sex (adjusted odds ratio [aOR], 1.6; 95% CI, 1.1-2.2), no GN POABP (aOR, 2.2; 95% CI, 1.5-3.3), and surgical duration ≥11.8 hours (aOR, 1.9; 95% CI, 1.3-2.7). Longer POABP durations (≥6 days) or antipseudomonal POABP had no association with SSI. Conclusions POABP without GN coverage was significantly associated with SSI and should be avoided. Antipseudomonal POABP or longer prophylaxis durations (≥6 days) were not protective against SSI. Antimicrobial stewardship interventions should be made to limit unnecessary antibiotic exposures, prevent the emergence of resistant organisms, and improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

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

Veve

Greene

Williams

et al. 2018

Otolaryngol.--head neck surg.

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“…Murphy et al [44] carried out a retrospective cohort study evaluating the rate of SSIs in patients undergoing osteomyocutaneous free flap reconstruction. Patients developed an SSI in 44% after administration of cefazolin (OR = 1.2, 95% CI 0.3-4.8), a little higher than the group treated with ampicillin-sulbactam (OR = 1) but not statistically significant (p = 0.73).…”

Section: Choice Of Antibiotic Agentmentioning

confidence: 99%

“…Three RCTs [41][42][43] and two retrospective cohort studies [10,44] comparing clindamycin and ampicillin-sulbactam in the prevention of SSIs in patients undergoing clean-contaminated head and neck surgery were included in a metaanalysis. The mean duration of follow-up in the included studies is 30 days; Weber et al [41] and Callender [43] mentioned no duration of follow-up.…”

Section: Comparison Between Ampicillin-sulbactam and Clindamycin: A Mmentioning

confidence: 99%

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

et al. 2020

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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.

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“…Several authors have found clindamycin to be inferior to other regimens and suggested the need to consider the addition of a second antibiotic to improve coverage of aerobic gram-negative bacteria. [162][163][164]195,196 Amoxicillin-sulbactam has been found to be superior to cefuroxime and other penicillins. 197 Studies have not found any benefit from prolonged duration of antibiotics in reducing postsurgical infections.…”

Section: Clean Head and Neck Surgery Recommendationmentioning

confidence: 99%

Evidence‐Based Use of Perioperative Antibiotics in Otolaryngology

Patel

Jayawardena

Walden

et al. 2018

Otolaryngol.--head neck surg.

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Objective To identify and clarify current evidence supporting and disputing the effectiveness of perioperative antibiotic use for common otolaryngology procedures. Data Sources PubMed, Embase (OVID), and CINAHL (EBSCO). Review Methods English-language, original research (systematic reviews/meta-analyses, randomized control trials, prospective or retrospective cohort studies, case-control studies, or case series) studies that evaluated the role of perioperative antibiotic use in common otolaryngology surgeries were systematically extracted using standardized search criteria by 2 investigators independently. Conclusions Current evidence does not support routine antibiotic prophylaxis for tonsillectomy, simple septorhinoplasty, endoscopic sinus surgery, clean otologic surgery (tympanostomy with tube placement, tympanoplasty, stapedectomy, and mastoidectomy), and clean head and neck surgeries (eg, thyroidectomy, parathyroidectomy, salivary gland excisions). Antibiotic prophylaxis is recommended for complex septorhinoplasty, skull base surgery (anterior and lateral), clean-contaminated otologic surgery (cholesteatoma, purulent otorrhea), and clean-contaminated head and neck surgery (violation of aerodigestive tract, free flaps). In these cases, antibiotic use for 24 to 48 hours postoperatively has shown equal benefit to longer duration of prophylaxis. Despite lack of high-quality evidence, the US Food and Drug Administration suggests antibiotic prophylaxis for cochlear implantation due to the devastating consequence of infection. Data are inconclusive regarding postoperative prophylaxis for nasal packing/splints after sinonasal surgery. Implications for Practice Evidence does not support the use of perioperative antibiotics for most otolaryngologic procedures. Antibiotic overuse and variability among providers may be due to lack of formal practice guidelines. This review can help otolaryngologists understand current evidence so they can make informed decisions about perioperative antibiotic usage.

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Surgical Site Infections in Patients Receiving Osteomyocutaneous Free Flaps to the Head and Neck. Does Choice of Antibiotic Prophylaxis Matter?

Cited by 41 publications

References 28 publications

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

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

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

Evidence‐Based Use of Perioperative Antibiotics in Otolaryngology

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