APOS-antibiotic prophylaxis for preventing infectious complications in orthognathic surgery: study protocol for a phase III, multicentre, randomised, controlled, double blinded, clinical trial with two parallel study arms

Antibiotic prophylaxis and surgical site infections in orthognathic surgery - a retrospective analysis

BACKGROUND

This study was conducted to determine surgical site infection (SSI) rates and potential risk factors as well as to evaluate antibiotic prophylaxis in orthognathic surgery.

METHODS

This retrospective observational study included patients who received orthognathic surgery. SSIs and their management were assessed for up to one year post-operatively. The applied antibiotic regime and other possible influencing factors (smoking, age, site of infection, drainage, duration of surgery, displacement distances, craniofacial malformations) were assessed.

RESULTS

In total 291 patient met the inclusion criteria (56.7% female). The mean age at surgery was 25.5 ± 8.5 years. Fifty-four patients (18.6%) were diagnosed with a craniofacial malformation. Relevant previous surgeries were documented in about one quarter of included patients (n = 75). Ninety-two percent of patients (n = 267) received intraoperative single-dose antibiotic prophylaxis. Surgical site infections occurred in 12.4% (n = 36) of patients. There was a significant association between postoperative infections and type of surgery (P = .037) as well as type of drainage (P = .002). Statistical analyses also revealed a higher prevalence of smokers (P = .036) and previous surgically assisted rapid palatal expansion (SARPE) (P = .018) in the infection group. Furthermore, no significant relationships were observed between postoperative infections and various co-factors (i.e. antibiotic regime, age at surgery, gender, associated craniofacial malformations, surgery duration, displacement distances, mandibular setback vs. advancement).

CONCLUSION

Low rates of SSIs occurred following an intraoperative single-dose antibiotic regime. None of the SSIs had a significant effect on the final surgical outcome. Present data do not warrant escalation of the antibiotic regimen. Postoperative smoking and capillary drainage should be avoided.

Use or abuse of antibiotics as prophylactic therapy in oral surgery: A systematic review

BACKGROUD

Antibiotics are a type of medication routinely prescribed by dental professionals; however, it is very common that the administration is not justified. Around 15% of dentists admit that they have administered antibiotics unnecessarily more than once a week. The objective of this project is to identify the effectiveness of the use of antibiotics as prophylactic therapy in oral surgery, and to carry out an analysis of the alternatives to pharmacological therapy.

METHODS

The search strategy was carried out in the PubMed, Scopus, and ScienceDirect databases. For study selection, a first filter was carried out by title and abstract, which mentioned the use of prophylactic antibiotics in some type of oral surgery. To establish the risk of bias, the JBI Critical Appraisal Checklist for Randomized Controlled Trials was utilized.

RESULTS

The type of antibiotics most prescribed as prophylactic therapy were beta-lactams, which were indicated in 100% of the studies. Penicillins predominated, observing amoxicillin as the most indicated drug in 54.1% of the studies (n = 13) followed by the use of amoxicillin in conjunction with clavulanic acid in 33.3% of the studies (n = 8). Of the 21 studies included, 17 mention that there is insufficient evidence to support the use of antibiotics as prophylactic therapy in patients who will undergo some type of oral surgery.

CONCLUSIONS

Without a doubt, the biggest challenge is to develop academic update strategies aimed at dentists with active clinical practice and dental students from educational and government institutions to provide updated information about the correct use of prescription drugs.

Association between the duration of antibiotic prophylaxis and surgical site infection after orthognathic surgery in Japan

PURPOSE

This study aimed to evaluate the risk factors for surgical site infection (SSI) after orthognathic surgery, focusing on the duration of prophylactic antibiotic administration in Japan.

STUDY DESIGN

The study included 181 patients who underwent orthognathic surgery at the Department of Oral and Maxillofacial Surgery of Yamagata University Hospital between 2012 and 2021. The clinical parameters of SSI were retrospectively investigated using patient charts. Logistic regression analysis was used to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) for risk factors for SSI after orthognathic surgery.

RESULTS

Nineteen patients (10.5%) were complicated with SSI. Male sex (OR, 3.638; 95% CI, 1.316-10.058) and an antibiotic prophylaxis duration ≤3 days (OR, 12.718; 95% CI, 1.639-98.673) were independent risk factors for SSI after orthognathic surgery.

CONCLUSION

Extended-term antibiotic prophylaxis was more effective for prevention of SSI after orthognathic surgery than short-term in this study.