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Increased Surgical Site Infection Rates following Clindamycin Use in Head and Neck Free Tissue Transfer
Christopher Pool1, Jason Kass2, John Spivack3
1Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Objective:
The development of surgical site infections (SSIs) can put the viability of free tissue transfer reconstructions at risk, often resulting in considerable postoperative morbidity and prolonged hospitalization. Current antibiotic prophylactic guidelines suggest a first- or second-generation cephalosporin with metronidazole for clean-contaminated cases and recommend clindamycin as an alternative choice in penicillin-allergic patients. This study was designed to examine the rates of postoperative infection associated with prophylactic antibiotic regimens, including patients receiving clindamycin as an alternative due to penicillin allergy.
Study Design:
Case series with chart review.
Setting:
Tertiary academic medical center.
Subjects:
Patients undergoing major ablative head and neck resection involving the pharynx and oral cavity reconstructed via free tissue transfer.
Methods:
The sample included patients (n = 266) who underwent free tissue transfer involving the oral cavity and pharynx from 2009 to 2014. Data included demographic data, medical comorbidities, anatomic tumor subsite and surgical procedure, and prophylactic antibiotic regimen. SSI data were examined up to 30 days after the initial surgical procedure. Multivariate logistic regression analysis was performed to determine the overall risk for SSI. Culture data were also reviewed.
Results:
The data indicated that clindamycin was associated with an approximate 4-fold increased risk for SSI (odds ratio, 3.784; 95% confidence interval: 1.367-10.470 [P = .010]) after controlling for possible confounding factors.
Conclusion:
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.
Insights
Clindamycin use in head and neck free tissue transfers increased surgical site infections (SSIs) risk by fourfold in penicillin-allergic patients. Alternative antibiotics with broader coverage are recommended to prevent SSIs.
Area of Science:
- Surgical Oncology
- Infectious Disease
- Oral and Maxillofacial Surgery
Background:
- Surgical site infections (SSIs) compromise free tissue transfer viability, leading to increased morbidity and hospitalization.
- Current guidelines recommend clindamycin for penicillin-allergic patients undergoing head and neck reconstruction.
Purpose of the Study:
- To evaluate postoperative infection rates associated with prophylactic antibiotic regimens, specifically clindamycin, in head and neck free tissue transfers.
- To identify the risk of SSIs in patients receiving clindamycin due to penicillin allergy.
Main Methods:
- Retrospective case series with chart review of 266 patients undergoing free tissue transfer for head and neck cancer reconstruction (2009-2014).
- Analysis of demographic data, comorbidities, tumor characteristics, surgical procedures, and prophylactic antibiotic regimens.
- Multivariate logistic regression to determine SSI risk factors; review of culture data.
Main Results:
- Clindamycin use was associated with a nearly 4-fold increased risk of SSIs (OR, 3.784; P = .010) after adjusting for confounding factors.
- The study controlled for potential variables influencing SSI development.
Conclusions:
- Clindamycin may be linked to a higher incidence of SSIs in head and neck free tissue transfers for penicillin-allergic patients.
- Broader gram-negative coverage with alternative antibiotics, such as cefuroxime, is recommended for penicillin-allergic patients undergoing these procedures.
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