Mapping the risk factors, pathogens, and antibiotic of pharyngocutaneous fistula in patients after neck open surgery

Weili Kong; Manlin Chen; Hailing Gu; Yinze Han; Yuanzhi Liu; Xiaoyan Xia; Hui Yang

doi:10.1007/s00405-024-08642-9

Mapping the risk factors, pathogens, and antibiotic of pharyngocutaneous fistula in patients after neck open surgery

Eur Arch Otorhinolaryngol. 2024 Apr 18. doi: 10.1007/s00405-024-08642-9. Online ahead of print.

Authors

Weili Kong^#¹, Manlin Chen^#¹, Hailing Gu¹, Yinze Han², Yuanzhi Liu², Xiaoyan Xia², Hui Yang³

Affiliations

¹ Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
² State Key Laboratory of Biological Therapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
³ Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. yh8806@163.com.

^# Contributed equally.

PMID: 38634896
DOI: 10.1007/s00405-024-08642-9

Abstract

Purpose: Current literature lacks consensus on risk factors for pharyngocutaneous fistula (PCF), and empirical antibiotic guidelines for PCF are limited. The aim of this study was to reduce the incidence of PCF and improve antibiotic treatment efficacy for patients with PCF after open neck surgery by analyzing their clinical characteristics, pathogenic bacteria, and antibiotic susceptibility.

Methods: This study was a 13-year single-center retrospective cohort study, including 699 patients who underwent open neck surgery for laryngeal and hypopharyngeal cancer. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors associated with the occurrence of PCF after surgery. The microbial species causing PCF were analyzed, and the antibiotic sensitivity of the top three pathogens was assessed. Venn diagrams were used to illustrate the antibiotics that exhibited 100% sensitivity against all three identified pathogens.

Results: The incidence of PCF after open neck surgery was 8%. Logistic univariate and multivariate analyses revealed that flap reconstruction (OR = 3.62, 95% CI [2.02-6.52]), history of preoperative radiotherapy (OR = 2.01, 95% CI [1.31-2.73]), significant postoperative bleeding (OR = 1.79, 95% CI [1.11-2.69]), and history of diabetes (OR = 1.34, 95% CI [1.29-2.46]) were significantly associated with PCF occurrence. Among the 38 cases of PCF patients, the top three identified pathogens were Pseudomonas aeruginosa, Escherichia coli, and Enterobacter cloacae. The antibiotics cefepime, meropenem, ticarcillin/clavulanic acid, and cefoperazone/sulbactam showed 100% sensitivity against these top three pathogens.

Conclusion: Special attention should be given to patients undergoing open neck surgery, especially those with intraoperative flap reconstruction, a history of preoperative radiotherapy, postoperative bleeding, or diabetes. Strengthening monitoring and care is crucial in preventing the occurrence of PCF. According to antibiotic usage guidelines and considering the distribution of pathogens in PCF patients, empirical antibiotic treatment with cefoperazone/sulbactam or ticarcillin/clavulanic acid is recommended prior to obtaining susceptibility test results.

Keywords: Antibiotic sensitivity; Pathogenic bacteria; Pharyngocutaneous fistula; Risk factors.