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Kong W, Chen M, Gu H, Han Y, Liu Y, Xia X, Yang H. Mapping the risk factors, pathogens, and antibiotic of pharyngocutaneous fistula in patients after neck open surgery. Eur Arch Otorhinolaryngol 2024; 281:4281-4289. [PMID: 38634896 DOI: 10.1007/s00405-024-08642-9] [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: 11/23/2023] [Accepted: 03/26/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Current literature lacks consensus on risk factors for pharyngocutaneous fistula (PCF), and empirical antibiotic guidelines for PCF are limited. The aim of this study was to reduce the incidence of PCF and improve antibiotic treatment efficacy for patients with PCF after open neck surgery by analyzing their clinical characteristics, pathogenic bacteria, and antibiotic susceptibility. METHODS This study was a 13-year single-center retrospective cohort study, including 699 patients who underwent open neck surgery for laryngeal and hypopharyngeal cancer. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors associated with the occurrence of PCF after surgery. The microbial species causing PCF were analyzed, and the antibiotic sensitivity of the top three pathogens was assessed. Venn diagrams were used to illustrate the antibiotics that exhibited 100% sensitivity against all three identified pathogens. RESULTS The incidence of PCF after open neck surgery was 8%. Logistic univariate and multivariate analyses revealed that flap reconstruction (OR = 3.62, 95% CI [2.02-6.52]), history of preoperative radiotherapy (OR = 2.01, 95% CI [1.31-2.73]), significant postoperative bleeding (OR = 1.79, 95% CI [1.11-2.69]), and history of diabetes (OR = 1.34, 95% CI [1.29-2.46]) were significantly associated with PCF occurrence. Among the 38 cases of PCF patients, the top three identified pathogens were Pseudomonas aeruginosa, Escherichia coli, and Enterobacter cloacae. The antibiotics cefepime, meropenem, ticarcillin/clavulanic acid, and cefoperazone/sulbactam showed 100% sensitivity against these top three pathogens. CONCLUSION Special attention should be given to patients undergoing open neck surgery, especially those with intraoperative flap reconstruction, a history of preoperative radiotherapy, postoperative bleeding, or diabetes. Strengthening monitoring and care is crucial in preventing the occurrence of PCF. According to antibiotic usage guidelines and considering the distribution of pathogens in PCF patients, empirical antibiotic treatment with cefoperazone/sulbactam or ticarcillin/clavulanic acid is recommended prior to obtaining susceptibility test results.
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Affiliation(s)
- Weili Kong
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Manlin Chen
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hailing Gu
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yinze Han
- State Key Laboratory of Biological Therapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuanzhi Liu
- State Key Laboratory of Biological Therapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoyan Xia
- State Key Laboratory of Biological Therapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui Yang
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Morioka H, Koizumi Y, Watariguchi T, Oka K, Tomita Y, Kojima Y, Okudaira M, Ito Y, Shimizu J, Watamoto K, Kato H, Nagaoka M, Yokota M, Hasegawa C, Tsuji T, Shimizu S, Ito K, Kawasaki S, Akita K, Kitagawa Y, Mutoh Y, Ishihara M, Iwata S, Nozaki Y, Nozawa M, Kato M, Katayama M, Yagi T. Surgical antimicrobial prophylaxis in Japanese hospitals: Real status and challenges. J Infect Chemother 2024; 30:626-632. [PMID: 38272262 DOI: 10.1016/j.jiac.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/24/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Information regarding the status of surgical antimicrobial prophylaxis (SAP) in Japanese hospitals is lacking. This study aimed to explore the status of SAP prescriptions for surgeries and adherence to Japanese SAP guidelines. METHODS From February to July 2020, a 1-day multicentre point prevalent survey was conducted at 27 hospitals in Aichi Prefecture, Japan. Patients prescribed SAP were included in this study. The appropriateness of the SAP was evaluated based on the guidelines for selection of antimicrobials and their duration. Surgery was defined as appropriate when all the items were appropriate. RESULTS A total of 728 patients (7.1 %; 728/10,199) received antimicrobials for SAP. Among them, 557 patients (76.5 %, 557/728) underwent the surgeries described in the guidelines. The overall appropriateness of all surgeries was 33.9 % (189/557). The appropriate selection of antimicrobial before/during and after surgery and their durations were 67.5 % (376/557), 67.5 % (376/557), and 43.3 % (241/557), respectively. The overall appropriateness ranged from 0 % (0/37, oral and maxillofacial surgery) to 58.7 % (88/150, orthopaedic surgery) and 27.7 % (36/130, community hospitals with 400-599 beds) to 47.2 % (17/36, specific hospitals). Cefazolin was the most prevalent antimicrobial prescribed before/during (55.5 %, 299/539), and after (45.1 %, 249/552) surgery. In total, 101 oral antimicrobials were prescribed postoperatively. CONCLUSIONS SAP adherence by specific surgical fields and hospitals was shown in this study. Intensive intervention and repeated surveillance are necessary to improve SAP prescriptions in Japanese hospitals.
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Affiliation(s)
- Hiroshi Morioka
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan.
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute, Japan; Department of Infection Prevention and Control, Wakayama Medical University, Wakayama, Japan
| | | | - Keisuke Oka
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan; Antimicrobial Stewardship Team, Kariya Toyota General Hospital, Kariya, Japan
| | - Yuka Tomita
- Department of Infectious Diseases, Japanese Red Cross Aichi Medical Centre Nagoya Daini Hospital, Nagoya, Japan
| | - Yumi Kojima
- Infection Control Team, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | | | - Yuji Ito
- Department of Respiratory Medicine, Daiyukai General Hospital, Ichinomiya, Japan
| | - Junichi Shimizu
- Department of Thoracic Oncology, Aichi Cancer Centre Hospital, Nagoya, Japan
| | - Koichi Watamoto
- Department of Hematology, Komaki City Hospital, Komaki, Japan
| | - Hiroki Kato
- Department of Infectious Diseases, Toyota Memorial Hospital, Toyota, Japan
| | | | - Manabu Yokota
- Department of Pharmacy, Handa City Hospital, Handa, Japan
| | - Chihiro Hasegawa
- Department of Infectious Diseases, Nagoya City East Medical Centre, Nagoya, Japan
| | - Takeshi Tsuji
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan
| | - Shinsuke Shimizu
- Infection Control Team, Kamiiida Daiichi General Hospital, Nagoya, Japan
| | - Kenta Ito
- Department of General Pediatrics, Aichi Children's Health and Medical Centre, Obu, Japan
| | - Shohei Kawasaki
- Department of Pharmacy, Nishichita General Hospital, Tokai, Japan
| | - Kenji Akita
- Department of Respiratory Medicine, Nagoya City University West Medical Centre, Nagoya, Japan
| | - Yuichi Kitagawa
- Department of Infection Control, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Yoshikazu Mutoh
- Department of Infectious Diseases, Tosei General Hospital, Seto, Japan
| | | | - Susumu Iwata
- Department of Respiratory Medicine, Kasugai Municipal Hospital, Kasugai, Japan
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine, Tokoname Municipal Hospital, Tokoname, Japan
| | | | - Munehiro Kato
- Department of Respiratory Medicine, Asahi Rosai Hospital, Owariasahi, Japan
| | - Masao Katayama
- Department of Internal Medicine and Rheumatology and Department of Infection Control Team, NHO Nagoya Medical Center, Nagoya, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan
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Mestrallet P, Yanni A, Roman A, Rodriguez A, Bouland C, Javadian R, Konopnicki D, Dequanter D. Antibiotic Use in Patients Undergoing Complex Clean-Contaminated Head and Neck Surgery: A Prospective Study. J Int Soc Prev Community Dent 2023; 13:349-355. [PMID: 37876581 PMCID: PMC10593369 DOI: 10.4103/jispcd.jispcd_25_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 10/26/2023] Open
Abstract
Aims and Objectives Oncological surgery of the upper aerodigestive tract is a complex procedure and often includes neck dissection and flap reconstruction. It can be complicated by severe surgical site infection (SSI) leading to flap necrosis, delayed wound healing, and increasing mortality and morbidity. The purpose of this study is to perform a systematic descriptive analysis and to evaluate the effect of our adapted antibiotic regimen strategy on postoperative outcomes. Materials and Methods A prospective cohort analysis of 47 patients undergoing major clean-contaminated head and neck surgery was conducted at the Cervicomaxillofacial Surgery Department (Saint-Pierre Hospital), between 2019 and 2022. The patients were divided into two groups: group I, which received a short-term postoperative antibiotic regimen for 24 h, and group II, which received a more extended postoperative antibiotic course for more than 24 h. Antibioprophylaxy amoxicillin and clavulanate were administered intravenously 30-60 min before making the incision. The antibiotic regimen was continued after surgery. The prognostic significance of the antibiotic regimen on postoperative outcomes, including clinical signs of infection and biological markers such as white blood cells count, and C-reactive protein levels was evaluated using univariate analysis. Results Eighteen patients developed SSIs. All of these infections were grade 2 and were treated with antibiotics. After univariate analysis, only a history of hypothyroidism seems to be a predictor of SSI (P = 0.038). No significant difference was found in terms of onset and hospital stay when we compared the patients who received antibiotics for 24 h or more. Moreover, the rate of multidrug-resistant bacteria was not different in both groups. Conclusions Our results suggest that postoperative antibiotics for more than 24 h do not confer benefit in terms of SSI. Oncological patients undergoing complex clean-contaminated head and neck surgery are often suffering from infectious complications and, despite the absence of guidelines, practicians should consider these findings in their decision-making.
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Affiliation(s)
- Pierre Mestrallet
- Department of Stomatology-Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Antoine Yanni
- Department of Stomatology-Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alain Roman
- Department of Intensive Care, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alexandra Rodriguez
- Department of Otolaryngolology-Head & Neck Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Cyril Bouland
- Department of Stomatology-Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Rokneddine Javadian
- Department of Stomatology-Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Deborah Konopnicki
- Department of Infectious Diseases, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Didier Dequanter
- Department of Stomatology-Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Otolaryngolology-Head & Neck Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Morioka H, Ohge H, Nagao M, Kato H, Kokado R, Yamada K, Yamada T, Shimono N, Nukui Y, Yoshihara S, Sakamaki I, Nosaka K, Kubo Y, Kawamura H, Fujikura Y, Kitaura T, Sunakawa M, Yagi T. Appropriateness of surgical antimicrobial prophylaxis in Japanese university hospitals. J Hosp Infect 2022; 129:189-197. [PMID: 35835283 DOI: 10.1016/j.jhin.2022.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to determine the adherence to the Japanese surgical antimicrobial prophylaxis (SAP) guidelines in Japanese university hospitals. DESIGN A retrospective cohort study. SETTING Fifteen general and one dental university hospitals. METHODS We evaluated up to three cases of 18 designated surgeries regarding adherence to Japanese SAP guidelines: selection of antibiotics, timing of administration, re-dosing intervals, and duration of SAP. When all items were appropriate, surgery was defined as 'appropriate.' RESULTS In total, 688 cases (22-45 cases per surgery) were included. The overall appropriateness was 46.8% (322/688), and the appropriateness of each surgery ranged from 8.0% (2/25, cardiac implantable electronic device implantation) to 92.1% (35/38, distal gastrectomy). The appropriateness of each item was as follows: pre/intraoperative selections, 78.5% (540/688); timing of administrations, 96.0% (630/656); re-dosing intervals, 91.8% (601/656); postoperative selection, 78.9% (543/688); and duration of SAP, 61.4% (423/688). The overall appropriateness of hospitals ranged from 17.6% (9/51) to 73.3% (33/45). The common reasons for inappropriateness were the longer duration (38.5%, 265/688) and choice of antibiotics with a non-optimal antimicrobial spectrum before/during, and after surgery (19.0%, 131/688 and 16.8%, 116/688, respectively), compared to the guideline. CONCLUSIONS Adherence to the guidelines differed greatly between the surgeries and hospitals. Large-scale multicentre surveillance of SAP in Japanese hospitals is necessary to identify inappropriate surgeries, factors related to the appropriateness, and incidences of surgical site infections.
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Affiliation(s)
- Hiroshi Morioka
- Nagoya University Hospital, Department of Infectious Diseases, Nagoya, Japan.
| | - Hiroki Ohge
- Hiroshima University, Project Research Center for Nosocomial Infectious Diseases, Hiroshima, Japan
| | - Miki Nagao
- Kyoto University Graduate School of Medicine, Department of Clinical Laboratory Medicine, Kyoto, Japan
| | - Hideaki Kato
- Yokohama City University Hospital, Infection Prevention and Control Department, Yokohama, Japan
| | - Ryohei Kokado
- Osaka University Hospital, Division of Infection Control and Prevention, Suita, Japan
| | - Koichi Yamada
- Osaka Metropolitan University, Graduate School of Medicine, Department of Infection Control Science, Osaka, Japan
| | - Takahiro Yamada
- Hamamatsu University School of Medicine, Department of Hospital Pharmacy, Hamamatsu, Japan
| | - Nobuyuki Shimono
- Kyushu University Hospital, Center for the Study of Global Infection, Fukuoka, Japan
| | - Yoko Nukui
- Tokyo Medical and Dental University Hospital, Department of Infection Control and Prevention, Bunkyo City, Japan; Kyoto Prefectural University of Medicine, Department of Infection Control and Laboratory Medicine
| | - Shingo Yoshihara
- Nara Medical University, Center for Infectious Diseases, Kashihara, Japan
| | - Ippei Sakamaki
- Toyama University Hospital, Department of Clinical Infectious Diseases, Toyama, Japan
| | - Kisato Nosaka
- Kumamoto University Hospital, Department of Hematology, Rheumatology and Infectious Disease, Kumamoto, Japan
| | - Yuko Kubo
- Hiroshima University Hospital, Department of Pharmaceutical Services, Hiroshima, Japan
| | - Hideki Kawamura
- Kagoshima University Hospital, Department of Infection Control and Prevention, Kagoshima, Japan
| | - Yuji Fujikura
- National Defense Medical College Hospital, Department of Medical Risk Management and Infection Control, Tokorozawa, Japan
| | - Tsuyoshi Kitaura
- Tottori University Hospital, Division of Infectious Diseases, Yonago, Japan
| | - Mitsuhiro Sunakawa
- Tokyo Medical and Dental University, Dental Hospital, Infection Control Team, Tokyo, Japan
| | - Tetsuya Yagi
- Nagoya University Hospital, Department of Infectious Diseases, Nagoya, Japan
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