Increased Surgical Site Infection Rates following Clindamycin Use in Head and Neck Free Tissue Transfer

Abstract

For patients with a true penicillin allergy, we recommend broader gram-negative coverage with alternative antibiotics, such as cefuroxime, when undergoing free tissue transfer in the head and neck.

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

“…In preparing this review, we found a wound infection rate after clean-contaminated head and neck surgery ranging between 2.5% and 64%, and polymicrobial in origin [6, 16-18, 27, 28, 35, 37-40]. Higher BMI, malnutrition, diabetes, liver disease, anemia, peripheral vascular disease, chronic obstructive pulmonary disease, immunosuppressive medication, and higher ASA score increase the risk of wound infection [10,[18][19][20][21][22][23][24]. Other factors include extensive surgery with flap reconstruction and neck dissection, previous chemotherapy, and a perioperative tracheotomy [7].…”

“…In general, a first-generation cephalosporin like cefazolin is the drug of choice; equally effective are amoxicillin-clavulanate and ampicillin-sulbactam, independent of the need for flap reconstruction [18,24,27]. Other antibiotics, such as benzylpenicillin [24] and clindamycin [5,8,10,19,23,27,38,43], are inferior. Of note, in the USA, ampicillin-sulbactam is available as a single pharmacologic preparation.…”

“…Diabetes [10,18,19], increased body mass index (BMI) [10,[19][20][21], malnutrition [21,22], anemia [10,21], and elevated American Society of Anesthesiologists (ASA) score [23,24] are associated with an increased risk of infection. Two studies [10,25] also identify undertreated hypothyroidism as a risk factor, whereas another study does not [19]. Tumor-related factors also play a role: according to Busch et al [7] the risk of infection is higher in patients with advanced disease (p = 0.012) and positive lymph nodes (p = 0.002).…”

“…Patients undergoing free flap reconstruction form a special entity in many aspects, but clindamycin is also less effective in this group. Pool et al [19] reviewed 266 patients undergoing head and neck free flap reconstruction and found that use of clindamycin implies a fourfold increased risk of wound infection (OR = 3.78, 95% CI 1.4-10.5). The same relation was found in an RCT [25] (OR = 2.54, 95% CI 1.…”

“…We found eight manuscripts comparing clindamycin to ampicillin-sulbactam. Three manuscripts were excluded: one systematic review [8] and two manuscripts with insufficient data available (number of events) [19,20].…”