0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Antibiotic Prophylaxis in Patients Undergoing Head and Neck Free Flap Reconstruction

Ryan M. Mitchell, MD, PhD1; Eduardo Mendez, MD, MS1; Nicole C. Schmitt, MD2; Amit D. Bhrany, MD1; Neal D. Futran, DMD, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
2Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Otolaryngol Head Neck Surg. 2015;141(12):1096-1103. doi:10.1001/jamaoto.2015.0513.
Text Size: A A A
Published online

Importance  Evidence supports short courses of perioperative antibiotics for patients receiving minor head and neck procedures. Few studies have addressed antibiotic prophylaxis for patients undergoing free flap reconstruction of head and neck defects.

Objective  To determine ideal antibiotic prophylaxis in patients undergoing head and neck free flap reconstruction.

Design, Setting, and Participants  Retrospective cohort study of 427 adults receiving free flap reconstruction of head and neck defects at 2 affiliated tertiary care academic hospitals between January 1, 2006, and January 28, 2013.

Exposures  Prophylactic antibiotic type and duration were recorded from patient records.

Main Outcomes and Measures  Outcome data were abstracted from patients’ medical records including infection at the surgical sites and distant nonsurgical sites and flap site complications including flap compromise, dehiscence, or fistula. Multivariate logistic regression was used to determine the association of risk factors with the primary outcome of any infection within 30 days of surgery.

Results  Ninety-six patients (22.5%) received prophylactic antibiotics for 24 hours or less, and 331 patients received prolonged courses of prophylactic antibiotics. The majority of patients received ampicillin-sulbactam alone for prophylaxis (53.2%), while 36.5% received clindamycin alone and 10.3% received an alternative regimen. Postoperative infections occurred in 46% of patients, and 22% of patients had an infection at the flap inset site or neck incision. The use of clindamycin (odds ratio [OR], 2.54; 95% CI, 1.25-5.14 [P = .01]) was associated with an increased risk of postoperative infection; extended duration of antibiotics (OR, 0.63; 95% CI, 0.34-1.19 [P = .18]) was not associated with increased risk of postoperative infection. By multivariate analysis, use of clindamycin (OR, 6.71; 95% CI, 1.83-24.60 [P = .004]) and oral tobacco use (OR, 1.20; 95% CI, 1.04-1.39 [P = .02]), but not extended course of prophylactic antibiotics (OR, 0.75; 95% CI, 0.30-1.86 [P = .53]), were associated with a higher risk of postoperative flap or neck infections.

Conclusions and Relevance  The choice of antibiotic appears to affect the rate of all postoperative infections and flap site infections more than the duration of antibiotics following head and neck free flap reconstruction. At our institutions, ampicillin-sulbactam is the preferred prophylactic antibiotic for major clean-contaminated head and neck procedures when possible.

Figures in this Article

Figures

Place holder to copy figure label and caption
Figure.
Duration of Prophylactic Antibiotics

A, A box plot showing the date of surgery vs the duration of prophylactic antibiotics. Prior December 2009, all patients received prolonged courses of prophylactic antibiotics, although the length was highly variable (median, 10.0 days). Starting in December 2009 we began to use shorter (≤24 hour) courses of antibiotics in many patients, although courses of longer duration were still highly variable (median, 1.5 days) (P < .001). Boxes represent interquartile ranges (IQRs) of the data, while each whisker represents data within 1.5 IQR of the nearest quartile. Outliers are shows as individual points. B, A histogram showing the duration of prophylactic antibiotics for each patient, demonstrating that 1-day and 7-day courses were the most commonly used.

Graphic Jump Location

Tables

References

Correspondence

CME


You need to register in order to view this quiz.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

1,581 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Characteristics of microorganisms cultured from infected wounds post-hysterectomy. Eur J Obstet Gynecol Reprod Biol 2008;141(2):169-72.
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence to Support the Update

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence Summary and Review 1

brightcove.createExperiences();