A prospective study of patients undergoing major
head and neck cancer surgery was undertaken to 1) define the value of
cefazolin prophylaxis in reducing the incidence of
wound infection, 2) define the value of preoperative and intraoperative (perioperative) cultures in identifying the patient at high risk of
wound infection and in predicting the bacteriology of subsequent
wound infection, and 3) demonstrate the most common aerobic and anaerobic flora of infected
wounds. Preoperatively, the neck skin, oropharynx and anterior nares were swabbed for aerobic cultures. An intraoperative
wound culture was obtained after the mucosal defect was sutured and the
wound irrigated with water and sent for aerobic culture. All infected
wounds were cultured for aerobic and anaerobic flora.
Cefazolin, 1 g, was given intramuscularly (IM) about two hours before the skin incision, and continued in 0.5 g doses IM or intravenously (IV) every six hours for four doses.
Cefazolin prophylaxis significantly reduced the incidence of
postoperative wound infection. Isolation of aerobic pathogens perioperatively was not correlated with a greater risk of
wound infection and did not accurately predict the flora of subsequent
wound infection. The most common pathogenic aerobes isolated from infected
wounds were Staphylococcus aureus and beta-Streptococcus not group A, as well as a variety of Gram-negative organisms. The most common anaerobic isolate was Bacteroides melaninogenicus.