Antibiotic Use after Free Tissue Reconstruction of Head and Neck Defects: Short Course vs. Long Course

Abstract

Background: Free tissue reconstruction has become the standard of care for most major defects in the head and neck. Surgical site infection (SSI) can lead to vessel thrombosis and eventual flap loss. The use of antibiotics after free tissue reconstruction has not been studied in the current environment of heightened bacterial antibiotic resistance. We compared the use of short-term and longer-term antibiotics in a series of patients receiving free tissue reconstructions. Methods: A retrospective review was performed of 147 patients receiving 149 free flaps who were treated with either short-course (£2 d; n = 149 [43%]) or long-course (>2 d; n = 85 [57%])) post-operative antibiotics from 2009 to 2014. The outcomes examined were infection, return to the operating room, length of hospital stay, and patient death up to six weeks post-surgery. In addition, risk factors associated with SSI were explored. Results: Surgical site infection, flap dehiscence, flap loss, and length of stay were not different in the two groups. However, those receiving long-course antibiotics had a significantly higher rate of pneumonia (24.7% vs. 10.9%; p = 0.03), although they had a lower rate of urinary tract infection (0.0% vs 9.4%, respectively; p = 0.01). Body mass index remained a statistically significant risk factor in the multivariable analysis (p = 0.005). Conclusion: Prolonged antibiotic use after free flap reconstruction of head and neck defects does not appear to prevent SSI better than short-course treatment in this population. Moreover, long-course antibiotic use was associated with a higher risk of pneumonia.

Antibiotic prophylaxis in clean‐contaminated head and neck cases with microvascular free flap reconstruction: A systematic review and meta‐analysis

“…Given the findings of a statistically significant reduction in recipient surgical site infections among those receiving prolonged antibiotic therapy, which differed from our null hypothesis, we performed a post hoc multivariate analysis to determine whether antibiotic type was associated with recipient surgical site infections, donor site surgical infections, distant infections, dehiscence/fistula, MRSA, and C. diff infections. Individual‐level data were required for this analysis and was available and obtained from the authors of 3 studies . A total of 697 patients from these were included.…”

“…The results of our electronic literature search and cross-referencing yielded 3 retrospective studies (level III of evidence), 33-35 1 prospective cohort study (level III of evidence), 32 and 1 randomized controlled clinical trial (level II of evidence), 31 for a total of 5 studies meeting inclusion criteria with sufficient available data to proceed with a meta-analysis (Table 2). [31][32][33][34][35] Four of the studies [32][33][34][35] required the raw data for inclusion in the metaanalysis, whereas 1 study 31 did not have available raw data but had sufficient data within the article for inclusion. Three of those 4 studies had information available for a post hoc analysis with individual-level data available, which included additional information about antibiotic type and risk of donor site surgical infections, distant infections, dehiscence/fistula, C. diff, and MRSA.…”

“…The Cochrane Cystic Fibrosis and Genetic Disorders November 2004 study selection, quality assessment, and data extraction form were used to assess study quality and extract the pertinent data from each article that met inclusion criteria. Ultimately, 5 studies were appropriate for inclusion . From the identified studies, we extracted relevant clinical information regarding the number of patients receiving short‐term (≤24 hours) prophylactic antibiotics, the number of patients receiving long‐term (>24 hours) prophylactic antibiotics, and the risk of recipient surgical site infection.…”

“…Ultimately, 5 studies were appropriate for inclusion. [31][32][33][34][35] From the identified studies, we extracted relevant clinical information regarding the number of patients receiving short-term (24 hours) prophylactic antibiotics, the number of patients receiving long-term (>24 hours) prophylactic antibiotics, and the risk of recipient surgical site infection. For studies reporting secondary endpoints of interest in the obtained raw data, we also extracted information of antibiotic type, rates of distant infections (UTIs or pneumonia), rates of methicillin-resistant staphylococcus aureus (MRSA) infections, and rates of Clostridium difficile (C. diff) gastrointestinal infections in the groups of patients receiving 24 hours and >24 hours of prophylactic antibiotics.…”

What is the preferred perioperative antibiotic choice and duration of use following major head and neck surgery?

“…Given the side effects of antibiotics and the emergence of multi‐drug resistant organisms, it is crucial to evaluate the benefits of prolonged antibiotic courses. Recently, a retrospective review of 147 patients undergoing free tissue reconstruction who were treated with either short‐course (< 2 days) or long‐course (> 2 days) postoperative antibiotics was performed . Surgical site infection, flap dehiscence, flap loss, and length of stay were similar between the two groups.…”