Multicenter Assessment of Antibiotic Prophylaxis Spectrum on Surgical Infections in Head and Neck Cancer Microvascular Reconstruction

Michael P. Veve, Joshua B. Greene, Amy M. Williams, Susan L. Davis, Nina Lu, Yelizaveta Shnayder, David X. Li, Salem I. Noureldine, Jeremy D. Richmon, Lawrence O. Lin, Matthew M. Hanasono, Patrik Pipkorn, Ryan S. Jackson, Joshua D. Hornig, Tyler Light, Mark Wax, Yin Yiu, James Bekeny, Matthew Old, David HernandezUrjeet A. Patel, Tamer A. Ghanem

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: To characterize and identify risk factors for 30-day surgical site infections (SSIs) in patients with head and neck cancer who underwent microvascular reconstruction. Study Design: Cross-sectional study with nested case-control design. Setting: Nine American tertiary care centers. Subjects and Methods: Hospitalized patients were included if they underwent head and neck cancer microvascular reconstruction from January 2003 to March 2016. Cases were defined as patients who developed 30-day SSI; controls were patients without SSI at 30 days. Postoperative antibiotic prophylaxis (POABP) regimens were categorized by Gram-negative (GN) spectrum: no GN coverage, enteric GN coverage, and enteric with antipseudomonal GN coverage. All POABP regimens retained activity against anaerobes and Gram-positive bacteria. Thirty-day prevalence of and risk factors for SSI were evaluated. Results: A total of 1307 patients were included. Thirty-day SSI occurred in 189 (15%) patients; median time to SSI was 11.5 days (interquartile range, 7-17). Organisms were isolated in 59% of SSI; methicillin-resistant Staphylococcus aureus (6%) and Pseudomonas aeruginosa (9%) were uncommon. A total of 1003 (77%) patients had POABP data: no GN (17%), enteric GN (52%), and antipseudomonal GN (31%). Variables independently associated with 30-day SSI were as follows: female sex (adjusted odds ratio [aOR], 1.6; 95% CI, 1.1-2.2), no GN POABP (aOR, 2.2; 95% CI, 1.5-3.3), and surgical duration ≥11.8 hours (aOR, 1.9; 95% CI, 1.3-2.7). Longer POABP durations (≥6 days) or antipseudomonal POABP had no association with SSI. Conclusions: POABP without GN coverage was significantly associated with SSI and should be avoided. Antipseudomonal POABP or longer prophylaxis durations (≥6 days) were not protective against SSI. Antimicrobial stewardship interventions should be made to limit unnecessary antibiotic exposures, prevent the emergence of resistant organisms, and improve patient outcomes.

Original languageEnglish (US)
JournalOtolaryngology - Head and Neck Surgery (United States)
DOIs
StateAccepted/In press - Mar 1 2018
Externally publishedYes

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Surgical Wound Infection
Antibiotic Prophylaxis
Head and Neck Neoplasms
Infection
Odds Ratio
Gram-Positive Bacteria
Methicillin-Resistant Staphylococcus aureus
Infection Control
Tertiary Care Centers
Pseudomonas aeruginosa
Cross-Sectional Studies

Keywords

  • antibiotic postoperative prophylaxis
  • antimicrobial stewardship
  • head and neck cancer microvascular reconstruction
  • surgical site infections

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Multicenter Assessment of Antibiotic Prophylaxis Spectrum on Surgical Infections in Head and Neck Cancer Microvascular Reconstruction. / Veve, Michael P.; Greene, Joshua B.; Williams, Amy M.; Davis, Susan L.; Lu, Nina; Shnayder, Yelizaveta; Li, David X.; Noureldine, Salem I.; Richmon, Jeremy D.; Lin, Lawrence O.; Hanasono, Matthew M.; Pipkorn, Patrik; Jackson, Ryan S.; Hornig, Joshua D.; Light, Tyler; Wax, Mark; Yiu, Yin; Bekeny, James; Old, Matthew; Hernandez, David; Patel, Urjeet A.; Ghanem, Tamer A.

In: Otolaryngology - Head and Neck Surgery (United States), 01.03.2018.

Research output: Contribution to journalArticle

Veve, MP, Greene, JB, Williams, AM, Davis, SL, Lu, N, Shnayder, Y, Li, DX, Noureldine, SI, Richmon, JD, Lin, LO, Hanasono, MM, Pipkorn, P, Jackson, RS, Hornig, JD, Light, T, Wax, M, Yiu, Y, Bekeny, J, Old, M, Hernandez, D, Patel, UA & Ghanem, TA 2018, 'Multicenter Assessment of Antibiotic Prophylaxis Spectrum on Surgical Infections in Head and Neck Cancer Microvascular Reconstruction', Otolaryngology - Head and Neck Surgery (United States). https://doi.org/10.1177/0194599818756299
Veve, Michael P. ; Greene, Joshua B. ; Williams, Amy M. ; Davis, Susan L. ; Lu, Nina ; Shnayder, Yelizaveta ; Li, David X. ; Noureldine, Salem I. ; Richmon, Jeremy D. ; Lin, Lawrence O. ; Hanasono, Matthew M. ; Pipkorn, Patrik ; Jackson, Ryan S. ; Hornig, Joshua D. ; Light, Tyler ; Wax, Mark ; Yiu, Yin ; Bekeny, James ; Old, Matthew ; Hernandez, David ; Patel, Urjeet A. ; Ghanem, Tamer A. / Multicenter Assessment of Antibiotic Prophylaxis Spectrum on Surgical Infections in Head and Neck Cancer Microvascular Reconstruction. In: Otolaryngology - Head and Neck Surgery (United States). 2018.
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title = "Multicenter Assessment of Antibiotic Prophylaxis Spectrum on Surgical Infections in Head and Neck Cancer Microvascular Reconstruction",
abstract = "Objective: To characterize and identify risk factors for 30-day surgical site infections (SSIs) in patients with head and neck cancer who underwent microvascular reconstruction. Study Design: Cross-sectional study with nested case-control design. Setting: Nine American tertiary care centers. Subjects and Methods: Hospitalized patients were included if they underwent head and neck cancer microvascular reconstruction from January 2003 to March 2016. Cases were defined as patients who developed 30-day SSI; controls were patients without SSI at 30 days. Postoperative antibiotic prophylaxis (POABP) regimens were categorized by Gram-negative (GN) spectrum: no GN coverage, enteric GN coverage, and enteric with antipseudomonal GN coverage. All POABP regimens retained activity against anaerobes and Gram-positive bacteria. Thirty-day prevalence of and risk factors for SSI were evaluated. Results: A total of 1307 patients were included. Thirty-day SSI occurred in 189 (15{\%}) patients; median time to SSI was 11.5 days (interquartile range, 7-17). Organisms were isolated in 59{\%} of SSI; methicillin-resistant Staphylococcus aureus (6{\%}) and Pseudomonas aeruginosa (9{\%}) were uncommon. A total of 1003 (77{\%}) patients had POABP data: no GN (17{\%}), enteric GN (52{\%}), and antipseudomonal GN (31{\%}). Variables independently associated with 30-day SSI were as follows: female sex (adjusted odds ratio [aOR], 1.6; 95{\%} CI, 1.1-2.2), no GN POABP (aOR, 2.2; 95{\%} CI, 1.5-3.3), and surgical duration ≥11.8 hours (aOR, 1.9; 95{\%} CI, 1.3-2.7). Longer POABP durations (≥6 days) or antipseudomonal POABP had no association with SSI. Conclusions: POABP without GN coverage was significantly associated with SSI and should be avoided. Antipseudomonal POABP or longer prophylaxis durations (≥6 days) were not protective against SSI. Antimicrobial stewardship interventions should be made to limit unnecessary antibiotic exposures, prevent the emergence of resistant organisms, and improve patient outcomes.",
keywords = "antibiotic postoperative prophylaxis, antimicrobial stewardship, head and neck cancer microvascular reconstruction, surgical site infections",
author = "Veve, {Michael P.} and Greene, {Joshua B.} and Williams, {Amy M.} and Davis, {Susan L.} and Nina Lu and Yelizaveta Shnayder and Li, {David X.} and Noureldine, {Salem I.} and Richmon, {Jeremy D.} and Lin, {Lawrence O.} and Hanasono, {Matthew M.} and Patrik Pipkorn and Jackson, {Ryan S.} and Hornig, {Joshua D.} and Tyler Light and Mark Wax and Yin Yiu and James Bekeny and Matthew Old and David Hernandez and Patel, {Urjeet A.} and Ghanem, {Tamer A.}",
year = "2018",
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TY - JOUR

T1 - Multicenter Assessment of Antibiotic Prophylaxis Spectrum on Surgical Infections in Head and Neck Cancer Microvascular Reconstruction

AU - Veve, Michael P.

AU - Greene, Joshua B.

AU - Williams, Amy M.

AU - Davis, Susan L.

AU - Lu, Nina

AU - Shnayder, Yelizaveta

AU - Li, David X.

AU - Noureldine, Salem I.

AU - Richmon, Jeremy D.

AU - Lin, Lawrence O.

AU - Hanasono, Matthew M.

AU - Pipkorn, Patrik

AU - Jackson, Ryan S.

AU - Hornig, Joshua D.

AU - Light, Tyler

AU - Wax, Mark

AU - Yiu, Yin

AU - Bekeny, James

AU - Old, Matthew

AU - Hernandez, David

AU - Patel, Urjeet A.

AU - Ghanem, Tamer A.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Objective: To characterize and identify risk factors for 30-day surgical site infections (SSIs) in patients with head and neck cancer who underwent microvascular reconstruction. Study Design: Cross-sectional study with nested case-control design. Setting: Nine American tertiary care centers. Subjects and Methods: Hospitalized patients were included if they underwent head and neck cancer microvascular reconstruction from January 2003 to March 2016. Cases were defined as patients who developed 30-day SSI; controls were patients without SSI at 30 days. Postoperative antibiotic prophylaxis (POABP) regimens were categorized by Gram-negative (GN) spectrum: no GN coverage, enteric GN coverage, and enteric with antipseudomonal GN coverage. All POABP regimens retained activity against anaerobes and Gram-positive bacteria. Thirty-day prevalence of and risk factors for SSI were evaluated. Results: A total of 1307 patients were included. Thirty-day SSI occurred in 189 (15%) patients; median time to SSI was 11.5 days (interquartile range, 7-17). Organisms were isolated in 59% of SSI; methicillin-resistant Staphylococcus aureus (6%) and Pseudomonas aeruginosa (9%) were uncommon. A total of 1003 (77%) patients had POABP data: no GN (17%), enteric GN (52%), and antipseudomonal GN (31%). Variables independently associated with 30-day SSI were as follows: female sex (adjusted odds ratio [aOR], 1.6; 95% CI, 1.1-2.2), no GN POABP (aOR, 2.2; 95% CI, 1.5-3.3), and surgical duration ≥11.8 hours (aOR, 1.9; 95% CI, 1.3-2.7). Longer POABP durations (≥6 days) or antipseudomonal POABP had no association with SSI. Conclusions: POABP without GN coverage was significantly associated with SSI and should be avoided. Antipseudomonal POABP or longer prophylaxis durations (≥6 days) were not protective against SSI. Antimicrobial stewardship interventions should be made to limit unnecessary antibiotic exposures, prevent the emergence of resistant organisms, and improve patient outcomes.

AB - Objective: To characterize and identify risk factors for 30-day surgical site infections (SSIs) in patients with head and neck cancer who underwent microvascular reconstruction. Study Design: Cross-sectional study with nested case-control design. Setting: Nine American tertiary care centers. Subjects and Methods: Hospitalized patients were included if they underwent head and neck cancer microvascular reconstruction from January 2003 to March 2016. Cases were defined as patients who developed 30-day SSI; controls were patients without SSI at 30 days. Postoperative antibiotic prophylaxis (POABP) regimens were categorized by Gram-negative (GN) spectrum: no GN coverage, enteric GN coverage, and enteric with antipseudomonal GN coverage. All POABP regimens retained activity against anaerobes and Gram-positive bacteria. Thirty-day prevalence of and risk factors for SSI were evaluated. Results: A total of 1307 patients were included. Thirty-day SSI occurred in 189 (15%) patients; median time to SSI was 11.5 days (interquartile range, 7-17). Organisms were isolated in 59% of SSI; methicillin-resistant Staphylococcus aureus (6%) and Pseudomonas aeruginosa (9%) were uncommon. A total of 1003 (77%) patients had POABP data: no GN (17%), enteric GN (52%), and antipseudomonal GN (31%). Variables independently associated with 30-day SSI were as follows: female sex (adjusted odds ratio [aOR], 1.6; 95% CI, 1.1-2.2), no GN POABP (aOR, 2.2; 95% CI, 1.5-3.3), and surgical duration ≥11.8 hours (aOR, 1.9; 95% CI, 1.3-2.7). Longer POABP durations (≥6 days) or antipseudomonal POABP had no association with SSI. Conclusions: POABP without GN coverage was significantly associated with SSI and should be avoided. Antipseudomonal POABP or longer prophylaxis durations (≥6 days) were not protective against SSI. Antimicrobial stewardship interventions should be made to limit unnecessary antibiotic exposures, prevent the emergence of resistant organisms, and improve patient outcomes.

KW - antibiotic postoperative prophylaxis

KW - antimicrobial stewardship

KW - head and neck cancer microvascular reconstruction

KW - surgical site infections

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U2 - 10.1177/0194599818756299

DO - 10.1177/0194599818756299

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JO - Otolaryngology - Head and Neck Surgery (United States)

JF - Otolaryngology - Head and Neck Surgery (United States)

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