Perioperative Piperacillin/Tazobactam Reduces Early Onset SSI in Preirradiated Patients Undergoing Microvascular Head
Johannes G Schuderer1, Florian Hoferer1, Jonas Eichberger1
1Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany.
Background:
Preirradiated patients undergoing microvascular head and neck reconstruction for tumor recurrence or osteoradionecrosis (ORN) face surgical site infection (SSI) rates exceeding 30%. The impact of perioperative extended-spectrum antibiotic coverage remains unclear. This study hypothesizes that calculated prophylaxis with piperacillin/tazobactam reduces early-onset SSI in this high-risk population.
Methods:
From a microvascular reconstructed cohort, 161 with prior irradiation were retrospectively identified (tumor, N = 101; ORN, N = 60). SSI risk reduction was compared between patients receiving piperacillin/tazobactam (N = 39) and standard prophylaxis (N = 122).
Results:
With underlying SSI incidence of 36%, piperacillin/tazobactam showed a fourfold SSI risk reduction (HR 0.24; p = 0.002) across the entire cohort and a fivefold reduction in patients with bone resection (HR 0.17; p = 0.01). Subgroup analyses confirmed this effect with a sevenfold reduction in tumor patients (HR 0.14; p = 0.008) and a threefold reduction in ORN patients (HR 0.29; p = 0.04). Extended coverage did not significantly prolong antibiotic treatment times.
Conclusion:
In summary, calculated use of piperacillin/tazobactam in previously irradiated patients requiring microvascular reconstruction appears effective in reducing early-onset SSI.
Insights
Piperacillin/tazobactam significantly reduced surgical site infections (SSI) in head and neck cancer patients who had prior radiation. This antibiotic prophylaxis is effective for high-risk microvascular reconstruction patients.
Area of Science:
- Head and Neck Surgery
- Surgical Oncology
- Infectious Disease
Background:
- Head and neck cancer patients undergoing microvascular reconstruction after radiation have >30% surgical site infection (SSI) rates.
- The effectiveness of extended-spectrum antibiotics for SSI prevention in this population is not well-established.
Purpose of the Study:
- To evaluate if calculated piperacillin/tazobactam prophylaxis reduces early-onset SSI in previously irradiated patients undergoing microvascular head and neck reconstruction.
Main Methods:
- Retrospective analysis of 161 patients with prior irradiation undergoing microvascular reconstruction.
- Comparison of SSI rates between patients receiving piperacillin/tazobactam (N=39) and standard prophylaxis (N=122).
Main Results:
- Piperacillin/tazobactam demonstrated a fourfold SSI risk reduction (HR 0.24) in the overall cohort.
- Significant SSI risk reduction was observed in tumor (HR 0.14) and osteoradionecrosis (ORN) (HR 0.29) subgroups.
- Extended antibiotic coverage did not prolong treatment duration.
Conclusions:
- Calculated piperacillin/tazobactam prophylaxis is effective in reducing early-onset SSI for previously irradiated patients undergoing microvascular reconstruction.
- This strategy offers a potential benefit for high-risk head and neck reconstruction patients.
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