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Antibiotic prophylaxis in clean-contaminated head and neck cases with microvascular free flap reconstruction: A
Yarah M Haidar1, Prem B Tripathi1, Tjoson Tjoa1
1Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, Irvine, California.
Background:
Optimal antibiotic prophylaxis duration in head and neck clean-contaminated free-flap cases is unknown.
Methods:
A systematic review/meta-analysis was conducted using PubMed/MEDLINE, Cochrane Library, Web-of-Science, and Scopus databases.
Results:
Of the 3755 searched articles, 5 articles were included for a total of 861 patients. The recipient surgical site infection risk was significantly higher in patients receiving prophylactic antibiotics for ≤24 hours compared to >24 hours (relative risk [RR] 1.56; 95% confidence interval [CI] 1.13-2.14). In the post hoc multivariate analysis based on available individual-level data on 697 patients from 3 studies, the risk of surgical site infection for ≤24 hours versus >24 hours was not significant after adjusting for antibiotic type (RR 1.09; 95% CI 0.78-1.55). When compared to ampicillin-sulbactam, patients who received clindamycin prophylaxis had an increased likelihood of recipient surgical site infection (RR 2.85; 95% CI 1.95-4.17).
Conclusion:
Less than or equal to 24 hours of antibiotic prophylaxis in head and neck clean-contaminated free-flap is likely sufficient but a strong conclusion remains elusive. Clindamycin prophylaxis increases the risk of recipient surgical site infection. Further prospective trials are necessary to clarify.
Insights
Optimal antibiotic prophylaxis for head and neck free flaps may be 24 hours or less, but clindamycin increases surgical site infection risk. Further research is needed to confirm optimal duration.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Infectious Diseases
Background:
- Optimal antibiotic prophylaxis duration for head and neck clean-contaminated free-flap surgery remains unclear.
- Surgical site infections (SSIs) are a significant concern in these complex procedures.
Purpose of the Study:
- To determine the optimal duration of antibiotic prophylaxis in head and neck clean-contaminated free-flap cases.
- To evaluate the impact of different antibiotic agents on SSI risk.
Main Methods:
- A systematic review and meta-analysis of relevant literature was performed.
- Searched databases included PubMed/MEDLINE, Cochrane Library, Web-of-Science, and Scopus.
- Five studies with 861 patients were included in the analysis.
Main Results:
- Initial analysis showed a higher SSI risk with prophylactic antibiotics for ≤24 hours versus >24 hours (RR 1.56).
- Post hoc multivariate analysis adjusting for antibiotic type found no significant difference in SSI risk based on duration (RR 1.09).
- Clindamycin prophylaxis was associated with a significantly increased risk of recipient SSI compared to ampicillin-sulbactam (RR 2.85).
Conclusions:
- Antibiotic prophylaxis of ≤24 hours may be sufficient for head and neck clean-contaminated free-flap procedures, though definitive conclusions require further investigation.
- Clindamycin should be used with caution due to its association with increased recipient SSI risk.
- Prospective trials are warranted to establish definitive antibiotic prophylaxis guidelines.
