Antibiotic Prophylaxis in Clean-contaminated Head and Neck Cases with Microvascular Free Flap Reconstruction: A Systematic Review and Meta-analysis

Overview

Journal Head Neck

Specialties General Surgery
Oncology

Date 2017 Oct 31

PMID 29083525

Citations 13

Authors

Yarah M Haidar

Prem B Tripathi

Tjoson Tjoa

Sartaaj Walia

Lishi Zhang

Yanjun Chen

Danh V Nguyen

Hossein Mahboubi

William B Armstrong

Julie A Goddard

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

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Antibiotic Use in Patients Undergoing Complex Clean-Contaminated Head and Neck Surgery: A Prospective Study.

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Osteocutaneous-flap-related osteomyelitis following mandibular reconstruction: a cohort study of an emerging and complex bone infection.

Javaux C, Daveau C, Bettinger C, Daurade M, Dupieux-Chabert C, Craighero F J Bone Jt Infect. 2022; 7(3):127-136.

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Postoperative Complications of Free Flap Reconstruction in Moderate-Advanced Head and Neck Squamous Cell Carcinoma: A Prospective Cohort Study Based on Real-World Data.

Li D, Wang C, Wei W, Li B, Liu H, Cheng A Front Oncol. 2022; 12:792462.

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