The non‐value of preoperative and intraoperative cultures in predicting the bacteriology of subsequent wound infection in patients undergoing major head and neck cancer surgery

Abstract

A prospective study of patients undergoing major head and neck cancer surgery was undertaken to define the value of preoperative and intraoperative cultures in identifying the patient at "high risk" of wound infection and in predicting the bacteriology of wound infection. One or two days before surgery, the skin of the operative site on the neck, the oropharynx and anterior nares were swabbed. an intraoperative wound culture was obtained after the pharyngeal defect was closed and the wound irrigated with water. All cultures were processed for aerobes in the Anaerobic Bacteriology Research Laboratory at Wadsworth Hospital Center. Wound infections developed in 10 of 31 patients who received cefazolin prophylactically and 21 of 25 patients who received no perioperative antibiotics. Fifty-five percent of infected patients and 68% of noninfected patients demonstrated potential pathogens preoperatively. A potential pathogen isolated preoperatively or intraoperatively was subsequently recovered from 35% of infected wounds. The majority of infected wound cultures grew one or more additional pathogens. A poor correlation was also noted between preoperative nasal Staphylococcus aureus isolation and subsequent recovery from wound infections. We conclude that preoperative and intraoperative aerobic wound cultures are not predictive of the "high risk" patient or of the bacteriology of subsequent wound infection in major head and neck cancer surgery.

A Descriptive Study of Bacterial Load of Full-Thickness Surgical Wounds in Dermatologic Surgery

“…In some patients, the bacterial species causative of the postsurgical complications differed from the species isolated intraoperatively. Previous studies focusing on intraoperative cultures to predict SSIs have shown varying results, 22–27 although in contrast to the present work, these studies did not quantify bacteria, which might further aid prediction of postoperative infections. Our work suggests that there is no predictive value of quantifying intraoperative bacteria.…”

Prevention and treatment of postsurgical head and neck infections

“…Becker and Parell [50] hypothesized that this increased incidence of infection may be in part attributable to the factor that necessitated the tracheostomy in the first place. Others have noted that patients with tracheostomy are frequently colonized with bacteria other than the usual oropharyngeal flora, in particular Pseudomonas, which may increase their risk for developing wound infection.…”

Antimicrobial Prophylaxis in Head and Neck Surgery

“…Studies have shown that preoperative and intraoperative cultures using material from the skin of the neck, the buccal cavity, the nasal mucosae and the operative wound are scarcely practicable and the findings do not necessarily correspond to those of any postoperative infection [2,3,4).…”

“…[3], tracheotomy is a procedure in which patients are particularly exposed to the risk of infection. Johnson et al [9] strongly rec ommends performing tracheotomy imme diately before the operation rather than sev eral days in advance.…”

“…In head and neck surgery, as in general surgical practice, the question of antimicro bial prophylaxis has given rise to much dis cussion [2,3], Certain types of intervention, most notably opening of the pharynx through the neck, have been the object of numerous investigations [1-11, 13, 16] aimed at ascer taining the usefulness of chemoprophylaxis in surgery involving an explicit risk.…”