Antibiotic prophylaxis in clean‐contaminated head and neck cases with microvascular free flap reconstruction: A systematic review and meta‐analysis

Background Optimal antibiotic prophylaxis duration in head and neck clean‐contaminated free‐flap cases is unknown. Methods A systematic review/meta‐analysis was conducted using PubMed/MEDLINE, Cochrane Library, Web‐of‐Science, and Scopus databases. Results Of the 3755 searched articles, 5 articles w...

Full description

Saved in:
Bibliographic Details
Published in:Head & neck 2018-02, Vol.40 (2), p.417-427
Main Authors: Haidar, Yarah M., Tripathi, Prem B., Tjoa, Tjoson, Walia, Sartaaj, Zhang, Lishi, Chen, Yanjun, Nguyen, Danh V., Mahboubi, Hossein, Armstrong, William B., Goddard, Julie A.
Format: Article
Language:English
Subjects:
Ampicillin
Antibiotics
clean‐contaminated
Clindamycin
Clinical trials
free flaps
Head and neck
Infections
Meta-analysis
microvascular surgery
Microvasculature
Multivariate analysis
prophylactic antibiotics
Prophylaxis
Sulbactam
surgical site infection
Surgical site infections
Systematic review
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Optimal antibiotic prophylaxis duration in head and neck clean‐contaminated free‐flap cases is unknown. Methods A systematic review/meta‐analysis was conducted using PubMed/MEDLINE, Cochrane Library, Web‐of‐Science, and Scopus databases. Results Of the 3755 searched articles, 5 articles were included for a total of 861 patients. The recipient surgical site infection risk was significantly higher in patients receiving prophylactic antibiotics for ≤24 hours compared to >24 hours (relative risk [RR] 1.56; 95% confidence interval [CI] 1.13‐2.14). In the post hoc multivariate analysis based on available individual‐level data on 697 patients from 3 studies, the risk of surgical site infection for ≤24 hours versus >24 hours was not significant after adjusting for antibiotic type (RR 1.09; 95% CI 0.78‐1.55). When compared to ampicillin‐sulbactam, patients who received clindamycin prophylaxis had an increased likelihood of recipient surgical site infection (RR 2.85; 95% CI 1.95‐4.17). Conclusion Less than or equal to 24 hours of antibiotic prophylaxis in head and neck clean‐contaminated free‐flap is likely sufficient but a strong conclusion remains elusive. Clindamycin prophylaxis increases the risk of recipient surgical site infection. Further prospective trials are necessary to clarify.
ISSN:1043-3074
1097-0347
DOI:10.1002/hed.24988