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Wang C, Lin L, Wu J, Fu G, Liu Z, Cao M. Development and validation of a novel nomogram model for identifying risk of prolonged length of stay among patients receiving free vascularized flap reconstruction of head and neck cancer. Front Oncol 2024; 14:1345766. [PMID: 38764582 DOI: 10.3389/fonc.2024.1345766.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/17/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND The aim of the present study was to build and internally validate a nomogram model for predicting prolonged length of stay (PLOS) among patients receiving free vascularized flap reconstruction of head and neck cancer (HNC). METHODS A retrospective clinical study was performed at a single center, examining patients receiving free vascularized flap reconstruction of HNC from January 2011 to January 2019. The variables were obtained from the electronic information system. The primary outcome measure was PLOS. Univariate and multivariate analyses were used to find risk factors for predicting PLOS. A model was then built according to multivariate results. Internal validation was implemented via 1000 bootstrap samples. RESULTS The study included 1047 patients, and the median length of stay (LOS) was 13.00 (11.00, 16.00) days. Multivariate analysis showed that flap types ((radial forearm free flap (odds ratio [OR] = 2.238; 95% CI, 1.403-3.569; P = 0.001), free fibula flap (OR = 3.319; 95% CI, 2.019-4.882; P < 0.001)), duration of surgery (OR = 1.002; 95% CI, 1.001-1.003; P = 0.004), postoperative complications (OR = 0.205; 95% CI, 0.129-0.325; P = P < 0.001) and unplanned reoperation (OR = 0.303; 95% CI, 0.140-0.653; P = 0.002) were associated with PLOS. In addition to these variables, blood transfusion was comprised in the model. The AUC of the model was 0.78 (95% CI, 0.711-0.849) and 0.725 (95% CI, 0.605-0.845) in the primary and internal validation cohorts, respectively. The DCA revealed the clinical utility of the current model when making intervention decisions within the PLOS possibility threshold range of 0.2-0.8. CONCLUSIONS Our study developed a nomogram that exhibits a commendable level of accuracy, thereby aiding clinicians in assessing the risk of PLOS among patients receiving free vascularized flap reconstruction for HNC.
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Affiliation(s)
- Chengli Wang
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University, Shanwei, China
| | - Liling Lin
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiayao Wu
- Department of Anesthesiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Ganglan Fu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhongqi Liu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University, Shanwei, China
| | - Minghui Cao
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University, Shanwei, China
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Wang C, Lin L, Wu J, Fu G, Liu Z, Cao M. Development and validation of a novel nomogram model for identifying risk of prolonged length of stay among patients receiving free vascularized flap reconstruction of head and neck cancer. Front Oncol 2024; 14:1345766. [PMID: 38764582 PMCID: PMC11099871 DOI: 10.3389/fonc.2024.1345766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/17/2024] [Indexed: 05/21/2024] Open
Abstract
Background The aim of the present study was to build and internally validate a nomogram model for predicting prolonged length of stay (PLOS) among patients receiving free vascularized flap reconstruction of head and neck cancer (HNC). Methods A retrospective clinical study was performed at a single center, examining patients receiving free vascularized flap reconstruction of HNC from January 2011 to January 2019. The variables were obtained from the electronic information system. The primary outcome measure was PLOS. Univariate and multivariate analyses were used to find risk factors for predicting PLOS. A model was then built according to multivariate results. Internal validation was implemented via 1000 bootstrap samples. Results The study included 1047 patients, and the median length of stay (LOS) was 13.00 (11.00, 16.00) days. Multivariate analysis showed that flap types ((radial forearm free flap (odds ratio [OR] = 2.238; 95% CI, 1.403-3.569; P = 0.001), free fibula flap (OR = 3.319; 95% CI, 2.019-4.882; P < 0.001)), duration of surgery (OR = 1.002; 95% CI, 1.001-1.003; P = 0.004), postoperative complications (OR = 0.205; 95% CI, 0.129-0.325; P = P < 0.001) and unplanned reoperation (OR = 0.303; 95% CI, 0.140-0.653; P = 0.002) were associated with PLOS. In addition to these variables, blood transfusion was comprised in the model. The AUC of the model was 0.78 (95% CI, 0.711-0.849) and 0.725 (95% CI, 0.605-0.845) in the primary and internal validation cohorts, respectively. The DCA revealed the clinical utility of the current model when making intervention decisions within the PLOS possibility threshold range of 0.2-0.8. Conclusions Our study developed a nomogram that exhibits a commendable level of accuracy, thereby aiding clinicians in assessing the risk of PLOS among patients receiving free vascularized flap reconstruction for HNC.
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Affiliation(s)
- Chengli Wang
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University, Shanwei, China
| | - Liling Lin
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiayao Wu
- Department of Anesthesiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Ganglan Fu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhongqi Liu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University, Shanwei, China
| | - Minghui Cao
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University, Shanwei, China
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Marwat MKUK, Laila L. Reducing Improper and Missed Peri-Procedure Antibiotics Prescriptions in a Regional Oncology Centre. Cureus 2024; 16:e59527. [PMID: 38827010 PMCID: PMC11144021 DOI: 10.7759/cureus.59527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Background In the realm of oncology care, patients undergoing invasive procedures are particularly vulnerable to infections due to their compromised immune systems. Antibiotics play a pivotal role in preventing such infections. However, inappropriate or missed administration of peri-procedure antibiotics poses a significant risk in the form of treatment complications, contributing to antibiotic resistance and increased healthcare costs. Methods The study was a two-cycle, closed-loop quality improvement project utilizing both retrospective and prospective data analysis of peri-procedure antibiotics prescription in a regional oncology centre. Two audit cycles were carried out in total; the first cycle was carried out in November 2023 where six-week data were collected retrospectively. As a result, formal and informal teaching sessions about the importance of correct peri-procedure antibiotics and the availability of complete institutional peri-procedure antibiotics guidelines in clinical areas were ensured. The second cycle was carried out prospectively for two weeks in January 2024. Patients were included if they underwent selected procedures performed by interventional radiology or gastroenterology while the patients operated on by the general surgeons and any day case procedures were excluded. Results We identified a total of 82 interventional procedures during the first cycle that fulfilled the inclusion criteria. Six out of 82 patients (7.3%) did not receive the correct peri-procedural antibiotics as per hospital antibiotics guidelines. A prospective two-week data after implementing the change revealed that 25 patients had documented interventional procedures done during this period using electronic patient records. Out of 25 patients, only one patient (4%) did not receive the peri-procedural antibiotics as per guidelines. We were able to demonstrate increased adherence to the peri-procedural guidelines (from 93% to 96%) during the two cycles. However, this change was not statistically significant (p = 0.50). Conclusion By educating and engaging healthcare professionals in adhering to evidence-based guidelines and best practices, we have observed notable, although statistically significant improvement in peri-procedure antibiotics prescription practices. Continued educational efforts and reinforcement strategies will be vital in further improvements over time. By providing ongoing support and resources, healthcare providers can be empowered to consistently make informed decisions regarding peri-procedure antibiotic administration. This commitment to maintaining high standards of antibiotic prescribing practices is expected to result in improved patient outcomes, including reduced rates of surgical site infections and antibiotic resistance. It is imperative to recognize the critical role that accurate peri-procedure antibiotic prescriptions play in patient safety and overall healthcare quality. By fostering a culture of continuous improvement and adherence to established guidelines, we can ensure that patients receive optimal care while minimizing the risks associated with antibiotic overuse or misuse.
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Affiliation(s)
| | - Laila Laila
- Oncology, Hull University Teaching Hospitals NHS Trust, Cottingham, GBR
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Hu Y, Yan A, Jiang F. Effect of Clindamycin compared with Ampicillin-Sulbactam as prophylactic antibiotics for wound infections following major surgery for head and neck cancer: A meta-analysis. Int Wound J 2023; 20:4151-4158. [PMID: 37483017 PMCID: PMC10681415 DOI: 10.1111/iwj.14312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023] Open
Abstract
A meta-analysis examination was implemented to review the effect of Clindamycin compared with Ampicillin-Sulbactam as prophylactic antibiotics (PAs) management for surgical site wound infections (SSWIs) following major surgery (MS) for head and neck cancer (H&NC). A comprehensive literature examination till May 2023 was done and 1296 interrelated examinations were reviewed. The six elected examinations, enclosed 4293 personals with MS for H&NC were in the utilized examinations' starting point, 1722 of them were utilizing Clindamycin, and 2571 were utilizing Ampicillin-Sulbactam. Odds ratio (OR) and 95% confidence intervals (CIs) were utilized to appraise the consequence of Clindamycin compared with Ampicillin-Sulbactam as PAs management for SSWIs following MS for H&NC by the dichotomous approach and a fixed or random model. Clindamycin had significantly higher SSWI compared with Ampicillin-Sulbactam (OR, 2.65; 95% CI, 1.40-5.02, p = 0.003) in personals with MS for H&NC. Clindamycin had significantly higher SSWI compared with Ampicillin-Sulbactam in personals with MS for H&NC. However, caution needs to be taken when interacting with its values because there was a low sample size of some of the chosen examinations and a low number of examinations found for the comparisons in the meta-analysis.
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Affiliation(s)
- Yue Hu
- Department of OtorhinolaryngologyThe First Hospital of China Medical UniversityShenyangLiaoningChina
| | - Aihui Yan
- Department of OtorhinolaryngologyThe First Hospital of China Medical UniversityShenyangLiaoningChina
| | - Feifei Jiang
- Department of OtorhinolaryngologyThe First Hospital of China Medical UniversityShenyangLiaoningChina
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Wang Y, Wang M, Hou L, Xiang F, Zhao X, Qian M. Incidence and risk factors of surgical site infection in patients with head and neck cancer: A meta-analysis. Head Neck 2023; 45:2925-2944. [PMID: 37676108 DOI: 10.1002/hed.27504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/08/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023] Open
Abstract
We systematically review the incidence and risk factors of surgical site infection (SSI) in patients with head and neck cancer. PubMed, Embase, Cochrane Library, and Web of Science databases were searched to obtain studies on the risk factors for SSI in patients with HNC. The retrieval time was from the establishment of the database to February 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in included studies. Meta-analysis was performed by using Stata 15.1 software. A total of 32 articles including 128 919 patients with head and neck cancer and 2949 cases of SSI were included in this meta-analysis. The incidence rate of SSI in head and neck cancer ranges from 19% to 29%, and the overall infection rate was 24%. Meta-analysis indicated that BMI < 20 kg/m2 (OR, 2.64; 95% CI, 1.74-4.00; I2 , 0%), diabetes (OR, 3.00; 95% CI, 2.12-4.16; I2 , 60.6%), ASA score (OR, 1.51; 95% CI, 1.29-1.77; I2 , 0%), radiotherapy (OR, 2.27; 95% CI, 1.87-2.77; I2 , 44.8%), chemotherapy (OR, 2.36; 95% CI, 1.64-3.40; I2 , 0%), clindamycin antibiotic (OR, 2.99; 95% CI, 1.82-2.93; I2 , 36.5%), deficit repair (OR, 3.76; 95% CI, 1.22-11.59; I2 , 91.4%), neck dissection (OR, 2.13; 95% CI, 1.63-2.79; I2 , 16.4%), blood transfusion (OR, 2.29; 95% CI, 1.52-3.45; I2 , 66.2%), mandibular (OR, 3.17; 95% CI, 1.85-5.42; I2 , 73%), tracheostomy (OR, 2.51; 95% CI, 1.74-3.62; I2 , 86.4%), operation time (OR, 1.42; 95% CI, 1.16-1.74; I2 , 86.4%), ALB (OR, 2.48; 95% CI, 1.95-3.15; I2 , 5.3%) were risk factors of surgical site infection in patients with head and neck cancer (p < 0.05). The results of the sensitivity analysis showed good agreement in all risk factors and the results had stability. The present meta-analysis suggests that BMI < 20 kg/m2 , diabetes, ASA score, radiotherapy, chemotherapy, clindamycin antibiotic, deficit repair, neck dissection, blood transfusion, mandibular, tracheostomy, operation time, and ALB were significant risk factors for SSI.
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Affiliation(s)
- Yu Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Nursing, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyi Wang
- Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Hou
- Department of Nursing, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuping Xiang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Nursing, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaomei Zhao
- Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meizhen Qian
- Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Shah R, Cohen O, Panth N, Dibble J, Paolillo D, Cook A, Mehra S. Prophylactic Intraoperative Antibiotic Dosing in Head and Neck Surgery: Opportunities for Improvement and Future Study. Otolaryngol Head Neck Surg 2023; 169:482-488. [PMID: 36113029 DOI: 10.1177/01945998221126144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/23/2022] [Indexed: 08/26/2023]
Abstract
OBJECTIVES To investigate rates of Surgical Care Improvement Project (SCIP) guideline adherence with regard to intraoperative antibiotic prophylaxis in head and neck surgery with free tissue transfer. STUDY DESIGN Retrospective case series. SETTING A single academic center. METHODS All patients who underwent mucosa-violating head and neck oncologic surgery with free tissue transfer between March 2017 and June 2019 were reviewed. Intraoperative antibiotic data included type, dosage, frequency of administration, and duration. Any deviation from SCIP recommendations was defined as nonadherence. Antibiotic type was categorized as ampicillin-sulbactam, cefazolin/metronidazole, clindamycin, and others. As a secondary exploratory analysis, postoperative infections were analyzed and stratified by adherent vs nonadherent and by antibiotic type. RESULTS A total of 129 surgical procedures were included. The mean ± SD number of antibiotic doses during surgery was 3.16 ± 1.2. The mean number of missed doses was 1.86 ± 1.65. Adherence rate with first dosing recommendation was 100%, as compared with 41.7% for dose 2, 23.1% for dose 3, 13.7% for dose 4, 5.26% for dose 5, 2.56% for dose 6, and 0% for dose 7 (P < .001). Ampicillin-sulbactam (6.4%) had a significantly lower rate of average redosing adherence when compared with cefazolin/metronidazole (73.2%) and clindamycin (63.3%; P < .001). CONCLUSION Significant opportunities exist in SCIP guideline adherence rates for intraoperative antibiotic prophylaxis. Cefazolin/metronidazole had a significantly higher rate of appropriate redosing when compared with ampicillin-sulbactam, which should be considered when choosing a prophylactic antibiotic regimen and performing antibiotic-based outcomes studies. More attention should be given to intraoperative antibiotic prophylaxis in head and neck surgery with free tissue transfer, as this presents an opportunity for quality improvement and future study heretofore not explored.
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Affiliation(s)
- Rema Shah
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Oded Cohen
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Neelima Panth
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Jacqueline Dibble
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Danielle Paolillo
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Amanda Cook
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
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Zirk M, Lentzen MP, Brost E, Schick V, Zöller JE, Zinser M. Surgical side infections of the tracheostomy - A retrospective cohort study of patients with head and neck cancer in intensive care. J Craniomaxillofac Surg 2022; 50:811-816. [PMID: 36336544 DOI: 10.1016/j.jcms.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 12/06/2021] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
This study was conducted to reveal the relevant risk factors for surgical site infections (SSI) of the tracheostomy in ICU tracheostomy patients with oncologic history. Retrospectively, medical and ICU records of patients who received open tracheostomy in a uniform manner were investigated. Of 187 consecutive patients in total, patients with a peri/post-operative antibiotic prophylaxis (POABP) experienced significantly more Organ-Space SSI, whereas patients with a POABP developed less Superficial Incisional SSI and Deep Incisional SSI. Neck Dissection (p = 0.025), especially the more levels are included, and POABP (p = 0.005) have a significant impact on the occurrence of an SSI of the tracheostomy. Deep incisional SSI significantly prolonged a patient's dependency on a ventilator (p = 0.045, M = 3.92, SD = 4.718). The difference between Superficial Incisional, Deep Incisional and Organ-Space SSI should be taken in consideration regarding risk evaluation and treatment. Furthermore, a gram-negative facultative anaerobic biofilm should be taken into consideration in treatment options and thus an escalation regarding antibiotic treatment as a POABP. For fulminant SSI of the tracheostomy the use of piperacillin/tazobactam or 3rd generation cephalosporines or carbapenems is recommendable.
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Affiliation(s)
- Matthias Zirk
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany, Head of Department: Prof. Dr. Dr. Joachim E. Zöller.
| | - Max-Philipp Lentzen
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany, Head of Department: Prof. Dr. Dr. Joachim E. Zöller
| | - Eliane Brost
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany, Head of Department: Prof. Dr. Dr. Joachim E. Zöller
| | - Volker Schick
- Department of Anaesthesiology and Intensive Care Medicine (Head: Prof. Dr. Bernd W. Böttiger), University Hospital of Cologne, Faculty of Medicine and University Hospital of Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany, Head of Department: Prof. Dr. Dr. Joachim E. Zöller
| | - Max Zinser
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Germany, Head of Department: Prof. Dr. Dr. Joachim E. Zöller
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Clindamycin use in head and neck surgery elevates the rate of infections in tracheostomies. Eur Arch Otorhinolaryngol 2022; 279:3581-3586. [PMID: 35333962 PMCID: PMC9130157 DOI: 10.1007/s00405-022-07349-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
Background Surgical site infection (SSI) in open surgical tracheostomy (ST) occurs in up to 33% of the cases. SSI can be reduced by a postoperative antibiotic prophylaxis (POAP). The effect of Clindamycin on SSIs in head and neck surgery (HNS) is discussed controversially in the literature. Methods An 8 year single-center retrospective comparative analysis of 441 STs (Visor-ST and Bjoerk-flap technique) performed within major HNS was evaluated due to the event of a SSI within 7 days and analyzed descriptively. Logistic regression model evaluated the impact of POAP with Clindamycin on SSIs. Results The use of Clindamycin showed twice the rate of ST-SSI as all patients that did not receive Clindamycin, treated with other perioperative antibiotics. (Fisher’s p = 0.008) The logistic regression model could not prove a statistically significant impact. (OR = 2.91, p = 0.04). Conclusion We recommend that Clindamycin should be reconsidered as a POAP regimen in ST. Further studies should evaluate alternatives for Penicillin-allergic patients. Level of evidence III Comparative retrospective monocentric study.
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Pitak-Arnnop P. An evidence-based approach to antibiotic prophylaxis for oral, craniomaxillofacial plastic/head and neck surgical procedures. J Clin Pharm Ther 2022; 47:844-850. [PMID: 35132644 DOI: 10.1111/jcpt.13618] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
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Matsui K, Kawakubo H, Matsuda S, Mayanagi S, Irino T, Fukuda K, Nakamura R, Wada N, Kitagawa Y. Clinical usefulness of sputum culture on the first postoperative day to predict early postoperative pneumonia after esophagectomy for esophageal cancer. Esophagus 2021; 18:773-782. [PMID: 33993389 DOI: 10.1007/s10388-021-00834-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Postoperative pneumonia is a serious prognostic problem that can appear after esophagectomy in patients with esophageal cancer. The past reports have considered the usefulness of perioperative culture examinations for predicting postoperative pneumonia; however, the direct relationship between these examinations and postoperative complications remains unclear. METHODS This study retrospectively analyzed esophageal cancer patients who underwent esophagectomy followed by sputum culture on the first postoperative day. The bacterial species that frequently cause hospital-acquired pneumonia were chosen as the target species in this study. The relationship between culture examination and postoperative pneumonia within one week (7 days) after esophagectomy was investigated. RESULTS Sputum cultures on the first postoperative day were investigated in 238 patients who underwent esophagectomy for esophageal cancer. Forty-one patients developed pneumonia within one week after surgery. The target bacterial species were detected in 26 of 238 sputum cultures (10.9%). In the univariate analysis, a Brinkman index, detection of target bacterial species, detection of Gram-positive cocci, and Gram-negative rods were significantly associated with postoperative pneumonia. In the three independent multivariate analyses, the target bacterial species, Gram-positive cocci, and Gram-negative rods (p = 0.001, 0.042, and < 0.001) were individually identified as independent risk factors of postoperative pneumonia in addition to a Brinkman index. CONCLUSIONS Detection of target bacterial species by sputum culture on the first postoperative day after esophagectomy was an independent risk factor of postoperative pneumonia within 7 days after surgery. Prospective studies for the prevention of early postoperative pneumonia using sputum culture on the first postoperative day can be considered.
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Affiliation(s)
- Kazuaki Matsui
- Department of Surgery, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shuhei Mayanagi
- Department of Surgery, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoyuki Irino
- Department of Surgery, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazumasa Fukuda
- Department of Surgery, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Norihito Wada
- Department of Surgery, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
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11
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Gearing PF, Daly JF, Tang NSJ, Singh K, Ramakrishnan A. Risk factors for surgical site infection in free-flap reconstructive surgery for head and neck cancer: Retrospective Australian cohort study. Head Neck 2021; 43:3417-3428. [PMID: 34409671 DOI: 10.1002/hed.26837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/30/2021] [Accepted: 07/29/2021] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Peter Francis Gearing
- The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - John Frederick Daly
- The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Nicholas Shi Jie Tang
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kasha Singh
- The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Victorian Infectious Diseases Unit, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
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12
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Alonso-García M, Toledano-Muñoz A, Aparicio-Fernández JM, De-la-Rosa-Astacio FM, Rodríguez-Villar D, Gil-de-Miguel A, Durán-Poveda M, Rodríguez-Caravaca G. Adequacy of antibiotic prophylaxis and incidence of surgical site infections in neck surgery. Sci Rep 2021; 11:16413. [PMID: 34385521 PMCID: PMC8361086 DOI: 10.1038/s41598-021-95831-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/28/2021] [Indexed: 01/21/2023] Open
Abstract
Health care-related infections are frequent and among them surgical site infection (SSI) are the most frequent in hospitals. The objective was to evaluate the adequacy of antibiotic prophylaxis in patients undergoing neck surgery and its relationship with the incidence of surgical site infection (SSI). Prospective cohort study. The adequacy of antibiotic prophylaxis in patients undergoing neck surgery was evaluated. Antibiotic prophylaxis was considered adequate when it conformed to all items of the protocol (antibiotic used, time of administration, administration route, dose and duration). The cumulative incidence of SSI was calculated, and the relationship between SSI and antibiotic prophylaxis adequacy was determined using adjusted relative risk (RR). Antibiotic prophylaxis was administered in 63 patients and was adequate in 85.7% (95% CI 75.0–92.3) of them. The cumulative incidence of SSI was 6.4% (95% CI 3.4–11.8). There was no significant relationship between antibiotic prophylaxis inadequacy and the incidence of SSI (RR = 2.4, 95% CI 0.6–10.6). Adequacy of antibiotic prophylaxis was high and it did not affect the incidence of SSIs.
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Affiliation(s)
- M Alonso-García
- Department of Preventive Medicine, Alcorcón Foundation University Hospital, C/ Budapest 1, 28922, Alcorcón, Madrid, Spain.,Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - A Toledano-Muñoz
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain.,Department of Otorhinolaryngology, Alcorcón Foundation University Hospital, Alcorcón, Madrid, Spain
| | - J M Aparicio-Fernández
- Department of Otorhinolaryngology, Alcorcón Foundation University Hospital, Alcorcón, Madrid, Spain
| | - F M De-la-Rosa-Astacio
- Department of Otorhinolaryngology, Alcorcón Foundation University Hospital, Alcorcón, Madrid, Spain
| | - D Rodríguez-Villar
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - A Gil-de-Miguel
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - M Durán-Poveda
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - G Rodríguez-Caravaca
- Department of Preventive Medicine, Alcorcón Foundation University Hospital, C/ Budapest 1, 28922, Alcorcón, Madrid, Spain. .,Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
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13
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Ramos-Zayas A, López-Medrano F, Urquiza-Fornovi I, Zubillaga I, Gutiérrez R, Sánchez-Aniceto G, Acero J, Almeida F, Galdona A, Morán MJ, Pampin M, Cebrián JL. The Impact of Healthcare-Associated Infections in Patients Undergoing Oncological Microvascular Head and Neck Reconstruction: A Prospective Multicentre Study. Cancers (Basel) 2021; 13:cancers13092109. [PMID: 33925543 PMCID: PMC8123773 DOI: 10.3390/cancers13092109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/10/2021] [Accepted: 04/22/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Healthcare-associated infections (HAIs) result in an increased morbidity and a delay in adjuvant therapy—thus increasing the cancer recurrence rates—in patients undergoing oncological microvascular head and neck reconstruction. HAIs also result in a cost increase for the Health System. We prospectively analysed the incidence, clinical characteristics, risk factors and impacts of these infections in 65 patients undergoing head and neck free-flap reconstruction in three third-level university hospitals in Madrid (Spain). The three of them implemented the same antibiotic prophylactic regimen for surgical interventions. The rate of HAIs was 61.54%. The following complications were significantly more frequent in patients with HAIs: need to reoperate (p = 0.009), duration of hospital admission (p < 0.001) and delay in starting radiotherapy (p = 0.009). This manuscript aims to point out the importance of preventing HAIs in head and neck cancer patients, as they have shown a higher risk of postoperative complications. Abstract (1) Background: Healthcare-associated infections (HAIs) after head and neck free-flap reconstruction are a common postoperative complication. Risk factors for HAIs in this context and their consequences have not been adequately described. (2) Methods: Ongoing prospective multicentre study between 02/2019 and 12/2020. Demographic characteristics and outcomes were analysed, focusing on infections. (3) Results: Forty out of 65 patients (61.54%) suffered HAIs (surgical site infection: 52.18%, nosocomial pneumonia: 23.20%, bloodstream infection: 13% and urinary tract infection: 5.80%). Methicillin-resistant Staphylococcus aureus (MRSA) and resistant Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter cloacae were the most frequently implicated. The significant risk factors for infection were: previous radiotherapy (Odds ratio (OR): 5.42; 95% confidence interval (CI), 1.39–21.10), anaemia (OR: 8.00; 95% CI, 0.96–66.95), salvage surgery (eight out of eight patients), tracheostomy (OR: 2.86; 95% CI, 1.01–8.14), surgery duration (OR: 1.01; 95% CI, 1.00–1.02), microvascular reoperation <72 h (eight/eight) and flap loss (eight/eight). The major surgical complications were: a need to reoperate (OR: 6.89; 95% CI, 1.42–33.51), prolonged hospital admission (OR: 1.16; 95% CI, 1.06–1.27) and delay in the initiation of postoperative radiotherapy (OR: 9.07; 95% CI, 1.72–47.67). The sixth month mortality rate in patients with HAIs was 7.69% vs. 0% in patients without HAIs (p = 0.50). (4) Conclusions: HAIs were common after this type of surgery, many of them caused by resistant microorganisms. Some modifiable risk factors were identified. Infections played a role in cancer prognosis by delaying adjuvant therapy.
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Affiliation(s)
- Ana Ramos-Zayas
- Oral and Maxillofacial Surgery Department, “12 de Octubre” University Hospital, Institute for Biomedical Research (i+12), Universidad Complutense, 28041 Madrid, Spain; (I.U.-F.); (I.Z.); (R.G.); (G.S.-A.)
- Correspondence: ; Tel.: +34-617955504
| | - Francisco López-Medrano
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Institute for Biomedical Research (i+12), Department of Medicine, School of Medicine, Universidad Complutense, 28041 Madrid, Spain;
| | - Irene Urquiza-Fornovi
- Oral and Maxillofacial Surgery Department, “12 de Octubre” University Hospital, Institute for Biomedical Research (i+12), Universidad Complutense, 28041 Madrid, Spain; (I.U.-F.); (I.Z.); (R.G.); (G.S.-A.)
| | - Ignacio Zubillaga
- Oral and Maxillofacial Surgery Department, “12 de Octubre” University Hospital, Institute for Biomedical Research (i+12), Universidad Complutense, 28041 Madrid, Spain; (I.U.-F.); (I.Z.); (R.G.); (G.S.-A.)
| | - Ramón Gutiérrez
- Oral and Maxillofacial Surgery Department, “12 de Octubre” University Hospital, Institute for Biomedical Research (i+12), Universidad Complutense, 28041 Madrid, Spain; (I.U.-F.); (I.Z.); (R.G.); (G.S.-A.)
| | - Gregorio Sánchez-Aniceto
- Oral and Maxillofacial Surgery Department, “12 de Octubre” University Hospital, Institute for Biomedical Research (i+12), Universidad Complutense, 28041 Madrid, Spain; (I.U.-F.); (I.Z.); (R.G.); (G.S.-A.)
| | - Julio Acero
- Oral and Maxillofacial Surgery Department, “Ramón y Cajal” University Hospital, Institute for Biomedical Research IRYCIS, Universidad de Alcalá, 28034 Madrid, Spain; (J.A.); (F.A.); (A.G.)
| | - Fernando Almeida
- Oral and Maxillofacial Surgery Department, “Ramón y Cajal” University Hospital, Institute for Biomedical Research IRYCIS, Universidad de Alcalá, 28034 Madrid, Spain; (J.A.); (F.A.); (A.G.)
| | - Ana Galdona
- Oral and Maxillofacial Surgery Department, “Ramón y Cajal” University Hospital, Institute for Biomedical Research IRYCIS, Universidad de Alcalá, 28034 Madrid, Spain; (J.A.); (F.A.); (A.G.)
| | - María José Morán
- Oral and Maxillofacial Surgery Department, “La Paz” University Hospital, Institute for Biomedical Research IdiPAZ, Universidad Autónoma, 28046 Madrid, Spain; (M.J.M.); (M.P.); (J.L.C.)
| | - Marta Pampin
- Oral and Maxillofacial Surgery Department, “La Paz” University Hospital, Institute for Biomedical Research IdiPAZ, Universidad Autónoma, 28046 Madrid, Spain; (M.J.M.); (M.P.); (J.L.C.)
| | - José Luis Cebrián
- Oral and Maxillofacial Surgery Department, “La Paz” University Hospital, Institute for Biomedical Research IdiPAZ, Universidad Autónoma, 28046 Madrid, Spain; (M.J.M.); (M.P.); (J.L.C.)
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14
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Hamill CS, Snyder V, Sykes KJ, O'Toole T. Prevalence of Multidrug-Resistant Organisms in Patients Undergoing Free Flap Reconstruction. Laryngoscope 2020; 131:E1881-E1887. [PMID: 33179795 DOI: 10.1002/lary.29268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/05/2020] [Accepted: 11/01/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study is to evaluate the relationship between antibiotic prophylaxis and prevalence of multidrug-resistant organisms (MDRO) in patients undergoing head and neck cancer reconstruction. STUDY DESIGN Retrospective Chart Review. METHODS Retrospective review of patients who underwent head and neck free flap reconstruction at our institution between 2009 to 2016. RESULTS Of the 145 patients that underwent head and neck tumor removal surgery using free tissue flaps to cover the defect and therafter received antibiotic prophylaxis, 30 (20.7%) developed postoperative surgical site (n = 17, 55.7%) or distant (n = 13, 43.4%) infections. Seven had a multidrug-resistant infection, the most common with Methicillin-Resistant Staphylococcus aureus (MRSA). There was no significant relationship between antibiotic spectrum or duration to the development of postoperative infections or MDRO. Pseudomonas and MRSA infections were low overall with only one multidrug-resistant Pseudomonas infection. CONCLUSIONS The choice of antibiotic prophylaxis should cover organisms these patients are at highest risk for including anaerobes and Gram-negative organisms. A shorter duration of antibiotic prophylaxis should be considered given no increased risk of postoperative infection nor MDRO. Finally, one must be aware of the potential threat of multidrug-resistant Pseudomonas and MRSA amongst this vulnerable population and identity these with culture driven treatment. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1881-E1887, 2021.
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Affiliation(s)
- Chelsea S Hamill
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve, Cleveland, Ohio, U.S.A
| | - Vusala Snyder
- Department of Otolaryngology- Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Kevin J Sykes
- Department of Otolaryngology- Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Thomas O'Toole
- Department of Otolaryngology, Head and Neck Surgery, Spectrum Health Medical Group, Grand Rapids, Michigan, U.S.A
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15
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Belusic-Gobic M, Zubovic A, Predrijevac A, Harmicar D, Cerovic R, Udovic Gobic S, Zubovic L. Microbiology of wound infection after oral cancer surgery. J Craniomaxillofac Surg 2020; 48:700-705. [PMID: 32522395 DOI: 10.1016/j.jcms.2020.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 05/06/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The aim of present study is to investigate the most common infection pathogen found in the postoperative wounds, following surgical treatment of oral and oropharyngeal cancer, in order to identify the most suitable antibiotic treatment. PATIENTS AND METHODS We analyzed patients with squamous cell cancer of oral and oropharyngeal region. In patients who developed postoperative wound infection, wound swabs were taken from three different sites: the cannula, wounds on the neck and wounds in the oral cavity. RESULTS In total 195 patients were included. The postoperative wound infection was detected in 115 patients (59%). In average, the swabs were taken 8 days after the surgery. The similar bacterial species from all three sites were detected in 24 patients (12,3%). In comparison, we found that there was statistically significant difference in the bacteria abundance from all three sites (p=0,031). There were significantly more bacteria in the wounds of the neck than cannula (p=0,007) and in the wounds in the oral cavity than cannula (p=0,002). No statistically significant difference between the wound on the neck and in the oral cavity was found. The most frequently isolated bacterial family was Enterobacteriaceae. Other more commonly isolated bacteria species were Staphylococcus spp. (G+), Pseudomonas aeruginosa (G-), Corynebacteruim spp. (G +) and Acinetobacter baumanii (G-). CONCLUSION Based on the most commonly isolated groups of pathogens we concluded that probably the best empiric antibiotic treatment of wound infections until antibiogram is completed might be achieved from the group of aminoglycosides or quinolones. Antibiotic therapy should be reviewed if necessary when antibiogram is completed.
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Affiliation(s)
| | - Arijan Zubovic
- Clinic for Maxillofacial Surgery, University Hospital Center Rijeka, Croatia.
| | - Anamarija Predrijevac
- Department of Anesthesiology, Reanimatology and Intensive Care, University of Rijeka, Rijeka, Croatia
| | - David Harmicar
- Clinic for Maxillofacial Surgery, University Hospital Center Rijeka, Croatia
| | - Robert Cerovic
- Clinic for Maxillofacial Surgery, University Hospital Center Rijeka, Croatia
| | - Silvana Udovic Gobic
- Teaching Institute of Public Health of Primorsko - Goranska Country, Mycrobiological Department, Specialist of Medical Microbiology and Parasitology, Croatia
| | - Lorena Zubovic
- Laboratory of Molecular and Cellular Neurobiology, Department of Cellular, Computational and Integrative Biology - CIBIO, University of Trento, Italy
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16
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Oppelaar MC, Zijtveld C, Kuipers S, Ten Oever J, Honings J, Weijs W, Wertheim HFL. Evaluation of Prolonged vs Short Courses of Antibiotic Prophylaxis Following Ear, Nose, Throat, and Oral and Maxillofacial Surgery: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2020; 145:610-616. [PMID: 31070697 DOI: 10.1001/jamaoto.2019.0879] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
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 (≤24 hours) vs extended-course antibiotic prophylaxis (≥72 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.
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Affiliation(s)
- Martinus C Oppelaar
- Division of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Christian Zijtveld
- Division of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Saskia Kuipers
- Division of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jaap Ten Oever
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jimmie Honings
- Division of Ear, Nose, and Throat Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem Weijs
- Division of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Heiman F L Wertheim
- Division of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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17
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Lindeborg MM, Sethi RKV, Puram SV, Parikh A, Yarlagadda B, Varvares M, Emerick K, Lin D, Durand ML, Deschler DG. Predicting length of stay in head and neck patients who undergo free flap reconstruction. Laryngoscope Investig Otolaryngol 2020; 5:461-467. [PMID: 32596488 PMCID: PMC7314462 DOI: 10.1002/lio2.410] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Understanding factors that affect postoperative length of stay (LOS) may improve patient recovery, hasten postoperative discharge, and minimize institutional costs. This study sought to (a) describe LOS among head and neck patients undergoing free flap reconstruction and (b) identify factors that predict increased LOS. METHODS A retrospective cohort was performed of 282 head and neck patients with free flap reconstruction for oncologic resection between 2011 and 2013 at a tertiary academic medical center. Patient demographics, tumor characteristics, and surgical and infectious complications were characterized. Multivariable regression identified predictors of increased LOS. RESULTS A total of 282 patients were included. Mean age was 64.7 years (SD = 12.2) and 40% were female. Most tumors were located in the oral cavity (53.9% of patients), and most patients underwent radial forearm free flap (RFFF) reconstruction (RFFF-73.8%, anterolateral thigh flap-11.3%, and fibula free flap-14.9%). Intraoperative complications were rare. The most common postoperative complications included nonwound infection (pneumonia [PNA] or urinary tract infection [UTI]) (15.6%) and wound breakdown/fistula (15.2%). Mean and median LOS were 13 days (SD = 7.7) and 10 days (interquartile range = 7), respectively. Statistically significant predictors of increased LOS included flap take back (Beta coefficient [C] = +4.26, P < .0001), in-hospital PNA or UTI (C = +2.52, P = .037), wound breakdown or fistula (C = +5.0, P < .0001), surgical site infection (C = +3.54, P = .017), and prior radiation therapy (C = +2.59, P = .004). CONCLUSION Several perioperative factors are associated with increased LOS. These findings may help with perioperative planning, including the need for vigilant wound care, optimization of antibiotics prophylaxis, and institution-level protocols for postoperative care and disposition of free flap patients. LEVEL OF EVIDENCE 2b; retrospective cohort.
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Affiliation(s)
- Michael M. Lindeborg
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Rosh K. V. Sethi
- Department of OtolaryngologyUniversity of MichiganAnn ArborMichiganUSA
| | - Sidharth V. Puram
- Department of OtolaryngologyWashington University School of Medicine in Saint LouisSaint LouisMissouriUSA
| | - Anuraag Parikh
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Bharat Yarlagadda
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Mark Varvares
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Kevin Emerick
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Derrick Lin
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Marlene L. Durand
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Daniel G. Deschler
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
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18
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Vander Poorten V, Uyttebroek S, Robbins KT, Rodrigo JP, de Bree R, Laenen A, F Saba N, Suarez C, Mäkitie A, Rinaldo A, Ferlito A. Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis. Adv Ther 2020; 37:1360-1380. [PMID: 32141017 PMCID: PMC7140756 DOI: 10.1007/s12325-020-01269-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Indexed: 12/31/2022]
Abstract
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 meta-analysis. RESULTS Thirty-nine studies were included in the systematic review. Compared with placebo, cefazolin, ampicillin-sulbactam, and amoxicillin-clavulanate were the most efficient agents. Benzylpenicillin and clindamycin were clearly less effective. Fifteen studies compared short- to long-term prophylaxis; treatment for more than 48 h did not further reduce wound infections. Meta-analysis of five clinical trials including 4336 patients, where clindamycin was compared with ampicillin-sulbactam, implied an increased infection rate for clindamycin-treated patients (OR = 2.73, 95% CI 1.50-4.97, p = 0.001). CONCLUSION In clean-contaminated head and neck surgery, cefazolin, amoxicillin-clavulanate, and ampicillin-sulbactam for 24-48 h after surgery were associated with the highest prevention rate of surgical site infection.
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Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Saartje Uyttebroek
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Antti Mäkitie
- Department of Otorhinolaryngology Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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19
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Vander Poorten V, Uyttebroek S, Robbins KT, Rodrigo JP, de Bree R, Laenen A, F Saba N, Suarez C, Mäkitie A, Rinaldo A, Ferlito A. Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis. Adv Ther 2020. [PMID: 32141017 DOI: 10.1007/s12325‐020‐01269‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
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 meta-analysis. RESULTS Thirty-nine studies were included in the systematic review. Compared with placebo, cefazolin, ampicillin-sulbactam, and amoxicillin-clavulanate were the most efficient agents. Benzylpenicillin and clindamycin were clearly less effective. Fifteen studies compared short- to long-term prophylaxis; treatment for more than 48 h did not further reduce wound infections. Meta-analysis of five clinical trials including 4336 patients, where clindamycin was compared with ampicillin-sulbactam, implied an increased infection rate for clindamycin-treated patients (OR = 2.73, 95% CI 1.50-4.97, p = 0.001). CONCLUSION In clean-contaminated head and neck surgery, cefazolin, amoxicillin-clavulanate, and ampicillin-sulbactam for 24-48 h after surgery were associated with the highest prevention rate of surgical site infection.
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Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Saartje Uyttebroek
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Antti Mäkitie
- Department of Otorhinolaryngology Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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20
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Evaluation of the efficacy of postoperative antibiotic treatment in transoral endoscopic thyroidectomy: a prospective randomised controlled trial. Br J Oral Maxillofac Surg 2020; 58:334-340. [PMID: 31982170 DOI: 10.1016/j.bjoms.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023]
Abstract
Transoral endoscopic thyroid surgery (TOET) is a new, minimally-invasive approach that does not result in a scar in the anterior neck. To prevent infection of the surgical site from oral cavity flora into the thyroidectomy area, postoperative antibiotics are generally given orally for 3-7 days. However, there is no clinical evidence to support this approach. This study was an open-label, randomised, controlled trial to evaluate the clinical usefulness of postoperative antibiotics given orally to patients having TOET. Patients were randomly assigned to receive amoxicillin-clavulanate 625mg orally three times a day for a week after operation (treated group) or no antibiotics (untreated group). Fifty patients - 25 treated and 25 untreated - were enrolled. Maximum body temperature, pulse rate, white blood cell count, and C-reactive protein concentrations did not differ between the two groups. Evaluation of the surgical site showed no significant differences between them. Seven patients in the treated group developed nausea, vomiting, and diarrhoea compared with none in the untreated group. The results suggest that postoperative oral antibiotics are not essential after TOET. Large-scale prospective series are required to confirm this finding.
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21
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A systematic review of latest evidence for antibiotic prophylaxis and therapy in oral and maxillofacial surgery. Infection 2019; 47:519-555. [DOI: 10.1007/s15010-019-01303-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/27/2019] [Indexed: 01/23/2023]
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22
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Haque M, McKimm J, Godman B, Abu Bakar M, Sartelli M. Initiatives to reduce postoperative surgical site infections of the head and neck cancer surgery with a special emphasis on developing countries. Expert Rev Anticancer Ther 2018; 19:81-92. [DOI: 10.1080/14737140.2019.1544497] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Grove Building, Swansea University, Swansea, Wales, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sasako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Muhamad Abu Bakar
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
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23
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Veve MP, Greene JB, Williams AM, Davis SL, Lu N, Shnayder Y, Li DX, Noureldine SI, Richmon JD, Lin LO, Hanasono MM, Pipkorn P, Jackson RS, Hornig JD, Light T, Wax MK, Yiu Y, Bekeny J, Old M, Hernandez D, Patel UA, Ghanem TA. Multicenter Assessment of Antibiotic Prophylaxis Spectrum on Surgical Infections in Head and Neck Cancer Microvascular Reconstruction. Otolaryngol Head Neck Surg 2018. [DOI: 10.1177/0194599818756299] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
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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Affiliation(s)
- Michael P. Veve
- Wayne State University, Detroit, Michigan, USA
- Henry Ford Health System, Detroit, Michigan, USA
| | | | | | - Susan L. Davis
- Wayne State University, Detroit, Michigan, USA
- Henry Ford Health System, Detroit, Michigan, USA
| | - Nina Lu
- Department of Otolaryngology, School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology, School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - David X. Li
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Lawrence O. Lin
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Patrik Pipkorn
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Ryan S. Jackson
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Joshua D. Hornig
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tyler Light
- Oregon Health Sciences University, Portland, Oregon, USA
| | - Mark K. Wax
- Oregon Health Sciences University, Portland, Oregon, USA
| | - Yin Yiu
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James Bekeny
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew Old
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | | | - Tamer A. Ghanem
- Wayne State University, Detroit, Michigan, USA
- Henry Ford Health System, Detroit, Michigan, USA
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24
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Patel PN, Jayawardena ADL, Walden RL, Penn EB, Francis DO. Evidence-Based Use of Perioperative Antibiotics in Otolaryngology. Otolaryngol Head Neck Surg 2018; 158:783-800. [DOI: 10.1177/0194599817753610] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Priyesh N. Patel
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Rachel L. Walden
- Annette and Irwin Eskind Biomedical Library, Vanderbilt University, Nashville, Tennessee, USA
| | - Edward B. Penn
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David O. Francis
- Division of Otolaryngology, Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
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25
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Veve MP, Davis SL, Williams AM, McKinnon JE, Ghanem TA. Considerations for antibiotic prophylaxis in head and neck cancer surgery. Oral Oncol 2017; 74:181-187. [PMID: 28943204 DOI: 10.1016/j.oraloncology.2017.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023]
Abstract
Peri/post-operative antibiotic prophylaxis (POABP) has become standard practice for preventing surgical site infections (SSI) in head and neck cancer patients undergoing microvascular reconstruction, but few data exist on optimal POABP regimens. Current surgical prophylaxis guideline recommendations fail to account for the complexity of microvascular reconstruction relative to other head and neck procedures, specifically regarding wound classification and antibiotic duration. Selection of POABP spectrum is also controversial, and must balance the choice between too narrow, risking subsequent infection, or too broad, and possible unwanted effects (e.g. antibiotic resistance, Clostridium difficile-associated diarrhea). POABP regimens should retain activity against bacteria expected to colonize the upper respiratory/salivary tracts, which include Gram-positive organisms and facultative anaerobes. However, Gram-negative bacilli also contribute to SSI in this setting. POABP doses should be optimized in order to achieve therapeutic tissue concentrations at the surgical site. Antibiotics targeted towards methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa are not warranted for all patients. Prolonged POABP durations have shown no differences in SSI when compared to short POABP durations, but prolonged durations provide unnecessarily antibiotic exposure and risk for adverse effects. Given the lack of standardization behind antibiotic POABP in this setting and the potential for poor patient outcomes, this practice necessitates an additional focus of surgeons and antimicrobial stewardship programs. The purpose of this review is to provide an overview of POABP evidence and discuss pertinent clinical implications of appropriate use.
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Affiliation(s)
- Michael P Veve
- University of Tennessee Health Science Center, College of Pharmacy, Knoxville, TN, USA; University of Tennessee Medical Center, Knoxville, TN, USA.
| | - Susan L Davis
- Wayne State University, Detroit, MI, USA; Henry Ford Health System, Detroit, MI, USA
| | | | | | - Tamer A Ghanem
- Wayne State University, Detroit, MI, USA; Henry Ford Health System, Detroit, MI, USA
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