The role of topical antibiotic prophylaxis in patients undergoing contaminated head and neck surgery with flap reconstruction

Citation
Jp. Simons et al., The role of topical antibiotic prophylaxis in patients undergoing contaminated head and neck surgery with flap reconstruction, LARYNGOSCOP, 111(2), 2001, pp. 329-335
Citations number
37
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Otolaryngology
Journal title
LARYNGOSCOPE
ISSN journal
0023-852X → ACNP
Volume
111
Issue
2
Year of publication
2001
Pages
329 - 335
Database
ISI
SICI code
0023-852X(200102)111:2<329:TROTAP>2.0.ZU;2-1
Abstract
Objectives/Hypothesis: Patients undergoing contaminated head and neck surge ry with nap reconstruction have wound infection rates of 20% to 25% with pa renteral antibiotic prophylaxis, Studies suggest that perioperative antimic robial mouthwash reduces oropharyngeal flora and may prevent wound infectio ns. We hypothesized that the addition of topical antibiotics to a parentera l prophylactic regimen would reduce the incidence of wound infection in the se high-risk patients. Study Design: We performed a randomized, prospective clinical trial. Methods: Patients received either 1) parenteral piperacill in/tazobactam (3.375 g every 6 hours for 48 h) or 2) parenteral piperacilli n/tazobactam plus topical piperacillin/tazobactam administered as a mouthwa sh immediately before surgery and once a day for 2 days postoperatively, wi th piperacillin/tazobactam added to the intraoperative irrigation solution. The wounds of all patients were evaluated daily using predefined objective criteria Results: Sixty-two patients met inclusion criteria and were enrol led in the study. The overall wound infection rate was 8.1% (95% confidence interval [CII, 2.7%-17.8%). Two of 31 patients (6.4%) who received parente ral antibiotics alone developed a wound infection compared with 3 of 31 pat ients (9.7%) randomly assigned to receive topical plus parenteral antibioti cs. This difference was not statistically significant (P = >.05). Infection rate was: not associated with nap type (rotational vs. free tissue transfe r), mandibular reconstruction, age, gender,tumor site, stage, surgical dura tion, or blood loss. Conclusions: These results suggest that piperacillin/t azobactam is a highly effective antibiotic for prevention of wound infectio n in patients undergoing flap reconstruction following contaminated head an d neck surgery, However, the addition of topical piperacillin/tazobactam do es not appear to enhance the prophylactic benefit of parenteral antibiotics alone.