Preliminary report of associated factors in wound infection after major head and neck neoplasm operations — does the duration of prophylactic antibiotic matter?

Abstract

The aim of this study was to investigate whether an extended course of prophylactic antibiotic could reduce the wound infection rate in a subtropical country. Fifty-three consecutive cases scheduled to receive major head and neck operations were randomised into one-day or three-day prophylactic antibiotic groups. Thirteen cases (24.5 per cent) developed wound infections after operations. The duration of prophylactic antibiotic was not related to the surgical wound infection. However, pre-operative haemoglobulin less than 10.5 g/dl (odds ratio: 7.24, 95 per cent confidence interval: 1.28-41.0) and reconstruction with a free flap or pectoris major myocutaneous flap during the operation (odds ratio: 11.04, 95 per cent confidence interval: 1.17-104.7) were associated factors significantly influencing post-operative wound infection. Therefore, one day of prophylactic antibiotic was effective in major head and neck procedures but should not be substituted for proper aseptic and meticulous surgical techniques.

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

“…However, there is still a high degree of variability in the implementation of peri-operative antibiotic prophylaxis. Given the greater risk of SSI in free flap reconstructions [9][10][11] and the potential highly morbid consequences of infection, many clinicians use antibiotics in an effort to prevent complications. Still, data attesting to the value of this practice are lacking.…”

“…Surgical site infection (SSI), one of the most common complications, may lead to vessel thrombosis and, eventually, to flap loss [6]. Moreover, reconstruction with free flaps is a significant risk factor for SSI in clean-contaminated head and neck operations [9][10][11]. Therefore, there has been great interest in determining the optimal regimen for antibiotic prophylaxis in the peri-operative period.…”

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…498 Postoperative SSI rates are affected by age, nutritional status, and the presence of concomitant medical conditions such as diabetes mellitus, anemia, and peripheral vascular disease. 496,[499][500][501][502][503][504] Use of tobacco, 498,505 alcohol, 505,506 or drugs of abuse 507 has also been associated with a higher risk of postoperative infection, particularly in patients with mandibular fracture. The hospital course, including length of hospitalization before operation, duration of antimicrobial use before operation, length of operation, presence of implants, and previous tracheotomy can also affect postoperative SSI rates.…”

“…497,498,[502][503][504] Procedure-related risk factors for infection include radical or bilateral neck dissections 501,508 and reconstruction with myocutaneous flaps or microvascular-free flaps. [497][498][499]508 Organisms. The normal floras of the mouth and the oropharynx are responsible for most infections that follow clean-contaminated head and neck procedures.…”

“…The normal floras of the mouth and the oropharynx are responsible for most infections that follow clean-contaminated head and neck procedures. 6,8,496,498,499,506,[509][510][511][512][513][514][515][516][517][518][519] Anaerobic and aerobic bacteria are abundant in the oropharynx. As a result, postoperative SSIs are usually polymicrobial and involve both aerobic and anaerobic bacteria.…”