Perioperative Antibiotics in the Setting of Oropharyngeal Reconstruction: Less Is More
Perioperative Antibiotics in the Setting of Oropharyngeal Reconstruction: Less Is More
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DOI：
10.1097/sap.0000000000000291
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发表时间：
2016-06-01
影响因子：
1.5
通讯作者：
Spector, Jason A.
中科院分区：
文献类型：
--
作者：
Cohen, Leslie E.;Finnerty, Brendan M.;Spector, Jason A.
背景口咽重建术后受体部位感染是一种潜在的灾难性并发症。虽然研究表明围手术期抗生素可将这些患者的感染率从87%降至20%，但对于最合适的抗生素方案和治疗时间，尚无共识。方法对2007-2013年间在同一机构由一名外科医生进行局部、带蒂或游离口咽瓣重建的所有患者进行了围手术期抗生素应用的回顾，以评估受体部位的并发症。结果97例患者接受了100次重建，其中61次游离皮瓣重建，39次带蒂/局部皮瓣重建，所有患者都接受了静脉(IV)抗生素的组合，以覆盖口腔菌群。受体部位并发症23例(23%)，包括蜂窝织炎(9%)、黏膜皮肤瘘(5%)、脓肿(5%)和伤口裂开(4%)。抗生素预防的持续时间，定义为少于48小时(短疗程)或大于48小时(长疗程)，并不是受体部位并发症的显著预测因素。受体部位并发症的显著危险因素是克林霉素预防(P<；0.008)、手术时间延长(P<；0.047)和高龄(P<；0.034)。受体部位的并发症被发现是住院时间延长(P<；0.001)和恢复肠道喂养时间延长(P<；0.035)的显著预测因素。结论这些数据表明，延长围手术期抗生素疗程并不能给口咽重建患者带来额外的好处。我们建议有限的48小时的预防性抗生素疗程，并有足够的需氧和厌氧覆盖，以帮助将抗生素相关疾病的发生率降至最低。
Background Recipient-site infection after oropharyngeal reconstruction is a potentially disastrous complication. Although studies suggest that perioperative antibiotics reduces infection rates in these patients from 87% to 20%, there is no consensus regarding what constitutes the most appropriate antibiotic regimen and duration of treatment.Methods A retrospective review of perioperative antibiotic administration was performed of all patients who underwent local, pedicled, or free flap oropharyngeal reconstruction after oncologic resection by a single surgeon at a single institution between 2007 and 2013 to assess for recipient-site complications.Results Ninety-seven patients underwent 100 reconstructions (61 free flap reconstructions, 39 pedicled/local flap reconstructions) and all received a combination of intravenous (IV) antibiotic agents designed to cover oral flora. There were 23 (23%) recipient-site complications, which included cellulitis (9%), mucocutaneous fistula (5%), abscess (5%), and wound dehiscence (4%). Duration of antibiotic prophylaxis, defined as less than 48 hours (short-course) or greater than 48 hours (long-course), was not a significant predictor of recipient-site complication. Significant risk factors for recipient-site complications were clindamycin prophylaxis (P < 0.008), increased duration of surgery (P < 0.047), and advanced age (P < 0.034). Recipient-site complication was found to be a significant predictor of both increased length of hospital stay (P < 0.001) and increased time to the resumption of enteral feeds (P < 0.035).Conclusions These data suggest that extended courses of perioperative antibiotics do not confer additional benefits in patients undergoing oropharyngeal reconstruction. We recommend a limited 48-hour course of prophylactic antibiotics with sufficient aerobic and anaerobic coverage to help minimize the incidence of antibiotic-related morbidities.