The role of topical antibiotic prophylaxis in patients undergoing contaminated head and neck surgery with flap reconstruction.

Abstract

OBJECTIVES/HYPOTHESIS:

Patients undergoing contaminated head and neck surgery with flap reconstruction have wound infection rates of 20% to 25% with parenteral antibiotic prophylaxis. Studies suggest that perioperative antimicrobial mouthwash reduces oropharyngeal flora and may prevent wound infections. We hypothesized that the addition of topical antibiotics to a parenteral prophylactic regimen would reduce the incidence of wound infection in these high-risk patients.

STUDY DESIGN:

We performed a randomized, prospective clinical trial.

METHODS:

Patients received either 1) parenteral piperacillin/tazobactam (3.375 g every 6 hours for 48 h) or 2) parenteral piperacillin/tazobactam plus topical piperacillin/tazobactam administered as a mouthwash immediately before surgery and once a day for 2 days postoperatively, with piperacillin/tazobactam added to the intraoperative irrigation solution. The wounds of all patients were evaluated daily using predefined objective criteria.

RESULTS:

Sixty-two patients met inclusion criteria and were enrolled in the study. The overall wound infection rate was 8.1% (95% confidence interval [CI], 2.7%-17.8%). Two of 31 patients (6.4%) who received parenteral antibiotics alone developed a wound infection compared with 3 of 31 patients (9.7%) randomly assigned to receive topical plus parenteral antibiotics. This difference was not statistically significant (P = >.05). Infection rate was not associated with flap type (rotational vs. free tissue transfer), mandibular reconstruction, age, gender, tumor site, stage, surgical duration, or blood loss.

CONCLUSIONS:

These results suggest that piperacillin/tazobactam is a highly effective antibiotic for prevention of wound infection in patients undergoing flap reconstruction following contaminated head and neck surgery. However, the addition of topical piperacillin/tazobactam does not appear to enhance the prophylactic benefit of parenteral antibiotics alone.

• Authors: J P Simons, J T Johnson, V L Yu, R M Vickers, W E Gooding, E N Myers, A M Pou, R L Wagner, J R Grandis
• Journal: The Laryngoscope (Laryngoscope) Vol. 111 Issue 2 Pg. 329-35 (Feb 2001) ISSN: 0023-852X [Print] United States
• PMID: 11210884 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Mouthwashes
• Penicillanic Acid
• Tazobactam
• Piperacillin

Topics

• Administration, Topical
• Adult
• Aged
• Antibiotic Prophylaxis
• Female
• Humans
• Infusions, Intravenous
• Male
• Middle Aged
• Mouthwashes
• Otorhinolaryngologic Neoplasms (surgery)
• Penicillanic Acid (administration & dosage, adverse effects, analogs & derivatives)
• Piperacillin (administration & dosage, adverse effects)
• Prospective Studies
• Surgical Flaps
• Surgical Wound Infection (prevention & control)
• Tazobactam
• Therapeutic Irrigation