Retrospective health-care associated infection surveillance in oral and maxillofacial reconstructive microsurgery

Abstract

In polymorbid or anaemic patients who receive preoperative radiotherapy or undergo long duration surgery involving potentially infectious sites, perioperative antibiotic prophylaxis (PAP) that is effective against normal oral bacterial flora is mandatory and plays an important role in preventing postoperative infection. In a four-year retrospective analysis, the incidence, outcome, and the efficacy of PAP were evaluated in patients treated at the Department of Oral and Maxillofacial Surgery and Otorhinolaryngology at Kecskemét Hospital. The results were compared with data from the literature to determine if the use of PAP was adequate at the Department.During the study period (between 01/09/2007 and 31/01/2011) 108 patients were evaluated. The mean duration of prophylactic antibiotic treatment was 8.3 ± 5.2 days, with cefotaxime+metronidazole being the most commonly used combination. Surgical site infection occurred in 8 patients (7.5%) in the clean-contaminated category.Our results showed that the perioperative antibiotic prophylaxis administered at our Department was efficient and effective against the oral bacterial flora of patients. Its use is recommended in head and neck microsurgery. To avoid development of antibiotic resistance and to reduce costs, it seems that the duration of antibiotic regimen for primary surgery can be reduced from 8.3 ± 5.2 days to 3 days.

The Impact of Healthcare-Associated Infections in Patients Undergoing Oncological Microvascular Head and Neck Reconstruction: A Prospective Multicentre Study

“…In the present cohort, the incidence of HAIs in microvascular free-flap head and neck reconstruction was 61.54%, and the incidence of SSI, with or without another infection, was 43.10% (52.18% of all HAIs). These figures, although relatively high, were consistent with the published literature [ 7 , 8 , 9 , 10 , 11 ].…”

“…Patients undergoing major head and neck surgical procedures are highly predisposed to develop postoperative complications. HAIs seem to be the most frequent one in the literature data [ 7 , 8 , 9 , 10 , 11 ]. To the best of our knowledge, the present study represents the largest prospective cohort assessing microbiological data, clinical characteristics and the outcomes of all types of HAIs among patients undergoing microvascular free flap in the head and neck region and the first study that implements a standardised antibiotic prophylaxis regimen.…”

“…When comparing the short-term (24-h regimen) vs. long-term (>24 h) use of antibiotics, the studies by Haidar et al and by Bartella et al both asserted that the risk of SSI was significantly higher in patients receiving prophylactic antibiotics ≤24 h compared to >24 h (OR 1.56 [ 27 ]), although the incidence of other nosocomial infections (pneumonia, UTI and sepsis) did not decrease under prolonged antibiotic prophylaxis [ 27 , 28 ]. On the other hand, certain authors encouraged short durations of broad-spectrum antibiotics, since long-term antibiotics did not appear to reduce the incidence of SSIs, with an increased risk of developing antibiotic resistance [ 7 , 19 , 26 , 31 ]. In summary, in the recent literature, no specific pattern of antibiotic prophylaxis has substantially proven to be effective.…”

“…The incidence rate of HAIs in hospital patients is a quality and safety indicator of patient care, being the most common complication of unsafe patient care worldwide [ 3 , 4 , 5 , 6 ]. Specifically, in patients undergoing microvascular head and neck reconstructions, the incidence of HAIs—headed by SSI [ 5 ]—is estimated as up to 44% [ 7 , 8 , 9 , 10 , 11 ]. Besides, HAIs differ from community-acquired infections in the microbiological pattern, and usually, the microorganisms involved tend to have higher rates of antibiotic resistance.…”

“…This could be explained by the complexity and length of microvascular reconstruction, as well as the large oncological resections that usually communicate the neck and the oral cavity, thus exposing cervical tissue to contaminated saliva and secretions from the respiratory and digestive tracts [ 17 ]. Nowadays, there is no consensus on the selection of antibiotics and whether to recommend them for or against the use of long-term antibiotic prophylaxis duration [ 5 , 7 , 9 , 18 , 19 ], due to the high incidence of patients suffering HAIs and the emergence of multidrug-resistant (MDR) bacteria.…”