Considerations for antibiotic prophylaxis in head and neck cancer surgery. (November 2017)

• Record Type: Journal Article
• Authors: Veve, Michael P.; Davis, Susan L.; Williams, Amy M.; McKinnon, John E.; Ghanem, Tamer A.
• Is Part Of: Oral oncology. Volume 74(2017)
• Page Start: 181
• Page End: 187
• Publication Date: 2017-11
• Subjects: Head and neck cancer -- Microvascular reconstruction -- Free tissue transfer -- Antibiotic prophylaxis -- Surgical site infections -- Antimicrobial stewardship -- Methicillin-resistant Staphylococcus aureus -- Pseudomonas aeruginosa; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2017.09.011
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Evidence for ideal antibiotic prophylaxis regimens is limited. Short antibiotic prophylaxis durations are as effective as longer durations. Prophylaxis should cover Gram-positive, anaerobic, and Gram-negative bacteria. Extended-spectrum prophylaxis (MRSA, P. aeruginosa ) is typically not warranted. Abstract: Peri/post-operative antibiotic prophylaxis (POABP) has become standard practice for preventing surgical site infections (SSI) in head and neck cancer patients undergoing microvascular reconstruction, but few data exist on optimal POABP regimens. Current surgical prophylaxis guideline recommendations fail to account for the complexity of microvascular reconstruction relative to other head and neck procedures, specifically regarding wound classification and antibiotic duration. Selection of POABP spectrum is also controversial, and must balance the choice between too narrow, risking subsequent infection, or too broad, and possible unwanted effects (e.g. antibiotic resistance, Clostridium difficile -associated diarrhea). POABP regimens should retain activity against bacteria expected to colonize the upper respiratory/salivary tracts, which include Gram-positive organisms and facultative anaerobes. However, Gram-negative bacilli also contribute to SSI in this setting. POABP doses should be optimized in order to achieve therapeutic tissue concentrations at the surgical site. Antibiotics targeted towards methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa are not warranted for all patients. Prolonged POABP durations have shown no differences in SSI when compared to short POABP durations, but prolonged durations provide unnecessarily antibiotic exposure and risk for adverse effects. Given the lack of standardization behind antibiotic POABP in this setting and the potential for poor patient outcomes, this practice necessitates an additional focus of surgeons and antimicrobial stewardship programs. The purpose of this review is to provide an overview of POABP evidence and discuss pertinent clinical implications of appropriate use.