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

Pierre Mestrallet; Antoine Yanni; Alain Roman; Alexandra Rodriguez; Cyril Bouland; Rokneddine Javadian; Deborah Konopnicki; Didier Dequanter

doi:10.4103/jispcd.JISPCD_25_23

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

J Int Soc Prev Community Dent. 2023 Aug 30;13(4):349-355. doi: 10.4103/jispcd.JISPCD_25_23. eCollection 2023 Jul-Aug.

Authors

Pierre Mestrallet¹, Antoine Yanni¹, Alain Roman², Alexandra Rodriguez³, Cyril Bouland¹, Rokneddine Javadian¹, Deborah Konopnicki⁴, Didier Dequanter^{1

3}

Affiliations

¹ Department of Stomatology-Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.
² Department of Intensive Care, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.
³ Department of Otolaryngolology-Head & Neck Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.
⁴ Department of Infectious Diseases, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.

Abstract

Aims and objectives: Oncological surgery of the upper aerodigestive tract is a complex procedure and often includes neck dissection and flap reconstruction. It can be complicated by severe surgical site infection (SSI) leading to flap necrosis, delayed wound healing, and increasing mortality and morbidity. The purpose of this study is to perform a systematic descriptive analysis and to evaluate the effect of our adapted antibiotic regimen strategy on postoperative outcomes.

Materials and methods: A prospective cohort analysis of 47 patients undergoing major clean-contaminated head and neck surgery was conducted at the Cervicomaxillofacial Surgery Department (Saint-Pierre Hospital), between 2019 and 2022. The patients were divided into two groups: group I, which received a short-term postoperative antibiotic regimen for 24 h, and group II, which received a more extended postoperative antibiotic course for more than 24 h. Antibioprophylaxy amoxicillin and clavulanate were administered intravenously 30-60 min before making the incision. The antibiotic regimen was continued after surgery. The prognostic significance of the antibiotic regimen on postoperative outcomes, including clinical signs of infection and biological markers such as white blood cells count, and C-reactive protein levels was evaluated using univariate analysis.

Results: Eighteen patients developed SSIs. All of these infections were grade 2 and were treated with antibiotics. After univariate analysis, only a history of hypothyroidism seems to be a predictor of SSI (P = 0.038). No significant difference was found in terms of onset and hospital stay when we compared the patients who received antibiotics for 24 h or more. Moreover, the rate of multidrug-resistant bacteria was not different in both groups.

Conclusions: Our results suggest that postoperative antibiotics for more than 24 h do not confer benefit in terms of SSI. Oncological patients undergoing complex clean-contaminated head and neck surgery are often suffering from infectious complications and, despite the absence of guidelines, practicians should consider these findings in their decision-making.

Keywords: Antibiotic; head; neck; oncology; prophylactic; surgery.