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Prevalence of Multidrug-Resistant Organisms in Patients Undergoing Free Flap Reconstruction
Chelsea S Hamill1, Vusala Snyder2, Kevin J Sykes3
1Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve, Cleveland, Ohio, U.S.A.
Objectives/Hypothesis:
The purpose of this study is to evaluate the relationship between antibiotic prophylaxis and prevalence of multidrug-resistant organisms (MDRO) in patients undergoing head and neck cancer reconstruction.
Study Design:
Retrospective Chart Review.
Methods:
Retrospective review of patients who underwent head and neck free flap reconstruction at our institution between 2009 to 2016.
Results:
Of the 145 patients that underwent head and neck tumor removal surgery using free tissue flaps to cover the defect and therafter received antibiotic prophylaxis, 30 (20.7%) developed postoperative surgical site (n = 17, 55.7%) or distant (n = 13, 43.4%) infections. Seven had a multidrug-resistant infection, the most common with Methicillin-Resistant Staphylococcus aureus (MRSA). There was no significant relationship between antibiotic spectrum or duration to the development of postoperative infections or MDRO. Pseudomonas and MRSA infections were low overall with only one multidrug-resistant Pseudomonas infection.
Conclusions:
The choice of antibiotic prophylaxis should cover organisms these patients are at highest risk for including anaerobes and Gram-negative organisms. A shorter duration of antibiotic prophylaxis should be considered given no increased risk of postoperative infection nor MDRO. Finally, one must be aware of the potential threat of multidrug-resistant Pseudomonas and MRSA amongst this vulnerable population and identity these with culture driven treatment.
Level Of Evidence:
4 Laryngoscope, 131:E1881-E1887, 2021.
Insights
Antibiotic prophylaxis in head and neck cancer reconstruction did not show a link to multidrug-resistant organisms (MDRO). Shorter antibiotic durations may be considered, but vigilance for MRSA and Pseudomonas is crucial.
Area of Science:
- Oncology
- Infectious Diseases
- Surgical Reconstruction
Background:
- Head and neck cancer reconstruction often involves free tissue flaps.
- Antibiotic prophylaxis is standard but its impact on multidrug-resistant organisms (MDRO) requires evaluation.
- Understanding infection risks is vital for patient outcomes.
Purpose of the Study:
- To assess the relationship between antibiotic prophylaxis and the prevalence of MDRO in head and neck cancer reconstruction patients.
- To determine if antibiotic spectrum or duration influences postoperative infection rates or MDRO development.
Main Methods:
- Retrospective chart review of 145 patients undergoing head and neck free flap reconstruction.
- Data collected on antibiotic prophylaxis, postoperative infections, and identified organisms.
- Analysis of infection sites (surgical site vs. distant) and causative agents.
Main Results:
- 20.7% of patients developed postoperative infections (surgical site or distant).
- Seven patients had multidrug-resistant infections, primarily Methicillin-Resistant Staphylococcus aureus (MRSA).
- No significant association found between antibiotic prophylaxis (spectrum or duration) and the development of postoperative infections or MDRO.
Conclusions:
- Antibiotic prophylaxis should target common pathogens like anaerobes and Gram-negative organisms.
- Shorter antibiotic durations may be safe, as no increased risk of infection or MDRO was observed.
- Awareness of potential multidrug-resistant Pseudomonas and MRSA is essential, guiding culture-driven treatment.
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