Schuderer, Johannes G. and Hoferer, Florian and Eichberger, Jonas and Fiedler, Mathias and Gessner, Andre and Hitzenbichler, Florian and Gottsauner, Maximilian and Maurer, Michael and Meier, Johannes K. and Reichert, Torsten E. and Ettl, Tobias (2024) Predictors for prolonged and escalated perioperative antibiotic therapy after microvascular head and neck reconstruction: a comprehensive analysis of 446 cases. HEAD & FACE MEDICINE, 20 (1): 58. ISSN , 1746-160X
Full text not available from this repository. (Request a copy)Abstract
Literature suggests that intravenous prophylaxis exceeding 48 h offers no additional benefit in preventing surgical site infections (SSI) in patients with microvascular head and neck reconstruction. However, protocols for antibiotic therapy duration post-reconstruction are not standardized. This study identifies factors predicting prolonged intravenous antibiotic use and antibiotic escalation in patients receiving free flap head neck reconstruction. A retrospective analysis of 446 patients receiving free flap reconstruction was conducted, examining predictors for antibiotic therapy > 10 days and postoperative escalation. 111 patients (24.8%) experienced escalation, while 159 patients (35.6%) received prolonged therapy. Multivariate regression analysis revealed predictors for escalation: microvascular bone reconstruction (p = 0.008, OR = 2.0), clinically suspected SSI (p < 0.001, OR = 5.4), culture-positive SSI (p = 0.03, OR = 2.9), extended ICU stay (p = 0.01, OR = 1.1) and hospital-acquired pneumonia (p = 0.01, OR = 5.9). Prolonged therapy was associated with bone reconstruction (p = 0.06, OR = 2.0), preoperative irradiation (p = 0.001, OR = 1.9) and culture-positive SSI (p < 0.001, OR = 3.5). The study concludes that SSIs are a primary factor driving the escalation of perioperative antibiotic use. Clinical suspicion of infection often necessitates escalation, even in the absence of confirmed microbiological evidence. Microvascular bone reconstruction was a significant predictor for both the escalation and extension of antibiotic therapy beyond 10 days. Furthermore, preoperative radiation therapy, hospital-acquired pneumonia, and prolonged ICU stay were associated with an increased likelihood of escalation, resulting in significantly extended antibiotic administration during hospitalization. Antibiotic stewardship programmes must be implemented to reduce postoperative antibiotic administration time.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | SURGICAL SITE INFECTION; CLEAN-CONTAMINATED HEAD; FREE-FLAP FAILURE; RISK-FACTORS; PROPHYLAXIS; PREVENTION; RESISTANCE; SURGERY; CARE; CHEMOTHERAPY; Head neck surgery; Microvascular reconstruction; Perioperative antibiotic prophylaxis; Surgical site infections |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin I Medicine > Lehrstuhl für Medizinische Mikrobiologie und Hygiene Medicine > Lehrstuhl für Mund-, Kiefer- und Gesichtschirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 22 Jul 2025 09:25 |
| Last Modified: | 22 Jul 2025 09:25 |
| URI: | https://pred.uni-regensburg.de/id/eprint/63597 |
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