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Bacteriologic profile of surgical infection after antibiotic prophylaxis
G L Clayman1, I I Raad, P D Hankins
1Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Abstract:
Wound infections resulting from contamination during major head and neck surgery continue to be a critical issue. In this study, specimens of pus or draining fluids from the wounds of 43 surgical patients who received perioperative administration of ampicillin/sulbactam or clindamycin were cultured for aerobic and anaerobic isolates to species level. Polymicrobial infections were identified in 13 of 43 patients (30%); 82% of isolates were aerobic organisms (45 of 55), and 18% were anaerobic or facultative species (10 of 55). Nine of 43 patients (21%) showed no bacterial isolates from cultured material. Independent of the primary site of malignancy or antibiotics used, nine of 25 isolates (36%) obtained from patients who underwent concomitant dental extractions, but only one of 24 (4%) who did not, developed anaerobic infections, (p < 0.001). The minimum inhibitory concentration of anaerobic isolates suggested sensitivity to the antibiotics used, and minimum bactericidal concentration data suggested that further postoperative doses may be required to adequately treat the heavily contaminated wounds. These data suggest that wound colonization following dental extraction procedures in clean contaminated head and neck surgery increases the risk of anaerobic infections. The use of a therapeutic dose and longer duration of perioperative antibiotics may be warranted.
Insights
Head and neck surgery patients with dental extractions face higher risks of anaerobic wound infections. Longer antibiotic durations may be needed to combat these infections effectively.
Area of Science:
- Surgical Infections
- Microbiology
- Head and Neck Surgery
Background:
- Wound infections are a significant complication in head and neck cancer surgery.
- Contamination during surgery can lead to polymicrobial infections, complicating treatment.
- Perioperative antibiotics like ampicillin/sulbactam and clindamycin are commonly used.
Purpose of the Study:
- To investigate the prevalence and characteristics of wound infections in head and neck surgery patients.
- To identify risk factors associated with specific types of microbial contamination.
- To evaluate the role of concomitant dental extractions in post-operative wound infections.
Main Methods:
- Culturing of wound pus or draining fluids from 43 head and neck surgery patients.
- Identification of aerobic and anaerobic bacterial isolates to the species level.
- Analysis of infection rates in patients with and without concomitant dental extractions.
Main Results:
- Polymicrobial infections were present in 30% of patients.
- Aerobic organisms predominated (82%), but anaerobic infections were significantly higher in patients with dental extractions (36% vs. 4%).
- Minimum inhibitory and bactericidal concentrations suggested potential need for extended antibiotic therapy.
Conclusions:
- Concomitant dental extractions increase the risk of anaerobic wound infections in head and neck surgery.
- Perioperative antibiotic regimens may require adjustments in duration and dosage for patients undergoing dental procedures.
- Further research into optimal antibiotic strategies for contaminated surgical sites is warranted.