The time course and microbiology of surgical site infections after head and neck free flap surgery. (25th November 2014)

• Record Type: Journal Article
• Authors: Durand, Marlene L.; Yarlagadda, Bharat B.; Rich, Debbie L.; Lin, Derrick T.; Emerick, Kevin S.; Rocco, James W.; Deschler, Daniel G.
• Is Part Of: Laryngoscope. Volume 125:Number 5(2015:May)
• Page Start: 1084
• Page End: 1089
• Publication Date: 2014-11-25
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.25038
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary25038-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>Determine the time of onset and microbiology of surgical site infections (SSIs) following head and neck free flap reconstructive surgeries.</p> </sec> <sec id="lary25038-sec-0002" sec-type="section"> <title>Study Design</title> <p>Retrospective cohort study.</p> </sec> <sec id="lary25038-sec-0003" sec-type="section"> <title>Methods</title> <p>All 504 free flap surgical cases (484 patients) performed April 1, 2009 to September 30, 2013 were reviewed; SSIs occurring ≤30 days postoperatively were evaluated. Admission screening for methicillin‐resistant <italic>Staphylococcus aureus</italic> (MRSA) colonization was performed on all patients.</p> </sec> <sec id="lary25038-sec-0004" sec-type="section"> <title>Results</title> <p>Flap‐recipient site infections (flap SSIs) occurred in 67 cases (13.3%), one‐third week 1 postoperatively, one‐third week 2, one‐third days 15 to 30; 45% occurred after hospital discharge. Wound cultures were polymicrobial, but 25% grew only normal oral flora, whereas 75% grew pathogens not part of normal oral flora, such as gram‐negative bacilli (44% of cases), MRSA (20%), and methicillin‐sensitive <italic>S aureus</italic> (MSSA) (16%). The frequency of these pathogens did not vary significantly by the time of SSI onset. In 67%, cultures included at least one pathogen resistant to the prophylactic antibiotic used. Clindamycin prophylaxis was a significant risk factor for flap SSI and for early partial or complete flap loss from infection. Donor SSIs occurred in 22 cases (4.4%), 95% >1 week postoperatively, and MRSA or MSSA were the primary pathogens in 89%. Of the 25 patients colonized with MRSA on admission, 40% developed a flap or donor SSI, a rate significantly higher than in non‐colonized patients.</p> </sec> <sec id="lary25038-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Gram‐negative bacilli, MRSA, and MSSA were significant SSI pathogens, and late onset of infection was common. Better screening, decolonization, and prophylaxis may reduce SSI rates.</p> </sec> <sec id="lary25038-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>2b <italic>Laryngoscope</italic>, 125:1084–1089, 2015</p> </sec> </abstract>