The clinical significance of the gastro-oral pathway of intestinal bacteria after head and neck cancer surgery.
Intestinal aerobic gram-negative bacilli (IAGB) are considered to be important in the pathogenesis of wound infection following major head and neck surgery. These micro-organisms have been shown to originate endogenously from the stomach, in spite of broad spectrum chemoprophylaxis. We have attempted to interrupt this gastro-oral pathway by instilling an antiseptic (40% ethanol) into the stomach after surgery. We studied 16 patients who were randomly allocated to an 'alcohol' or control group. Alcohol was administered to 8 patients regularly via the nasogastric tube until the 5th postoperative day. The mouth, tracheostomy site and gastric aspirates were sampled on the 1st, 5th, and 10th days after surgery. No patients had IAGB grown from the mouth before surgery, but after surgery coliforms were prolific in all sites in both patient groups, and the administration of alcohol did not have any noticeable affect. However, even though coliforms were ubiquitous during the recovery period, wound complications were few, and their importance in the pathogenesis of wound sepsis is reconsidered.
Swift
A C
AC
University Department of Otorhinolaryngology, Royal Liverpool Hospital.
Bartzokas
C A
CA
Corkill
J E
JE
D000328:Adult; D000368:Aged; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006088:Gram-Negative Aerobic Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D011897:Random Allocation; D013270:Stomach / Q000382:microbiology; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control
D000431:Ethanol