title: The role of topical antibiotic prophylaxis in patients undergoing contaminated head and neck surgery with flap reconstruction.
abstract: OBJECTIVE
  Patients undergoing contaminated head and neck surgery with flap reconstruction have wound infection rates of 20% to 25% with parenteral antibiotic prophylaxis. Studies suggest that perioperative antimicrobial mouthwash reduces oropharyngeal flora and may prevent wound infections. We hypothesized that the addition of topical antibiotics to a parenteral prophylactic regimen would reduce the incidence of wound infection in these high-risk patients.
  
  
  METHODS
  We performed a randomized, prospective clinical trial.
  
  
  METHODS
  Patients received either 1) parenteral piperacillin/tazobactam (3.375 g every 6 hours for 48 h) or 2) parenteral piperacillin/tazobactam plus topical piperacillin/tazobactam administered as a mouthwash immediately before surgery and once a day for 2 days postoperatively, with piperacillin/tazobactam added to the intraoperative irrigation solution. The wounds of all patients were evaluated daily using predefined objective criteria.
  
  
  RESULTS
  Sixty-two patients met inclusion criteria and were enrolled in the study. The overall wound infection rate was 8.1% (95% confidence interval [CI], 2.7%-17.8%). Two of 31 patients (6.4%) who received parenteral antibiotics alone developed a wound infection compared with 3 of 31 patients (9.7%) randomly assigned to receive topical plus parenteral antibiotics. This difference was not statistically significant (P = >.05). Infection rate was not associated with flap type (rotational vs. free tissue transfer), mandibular reconstruction, age, gender, tumor site, stage, surgical duration, or blood loss.
  
  
  CONCLUSIONS
  These results suggest that piperacillin/tazobactam is a highly effective antibiotic for prevention of wound infection in patients undergoing flap reconstruction following contaminated head and neck surgery. However, the addition of topical piperacillin/tazobactam does not appear to enhance the prophylactic benefit of parenteral antibiotics alone.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh Cancer Institute, Pennsylvania 15213, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Simons
authors.forename: J T
authors.initials: JT
authors.lastname: Johnson
authors.forename: V L
authors.initials: VL
authors.lastname: Yu
authors.forename: R M
authors.initials: RM
authors.lastname: Vickers
authors.forename: W E
authors.initials: WE
authors.lastname: Gooding
authors.forename: E N
authors.initials: EN
authors.lastname: Myers
authors.forename: A M
authors.initials: AM
authors.lastname: Pou
authors.forename: R L
authors.initials: RL
authors.lastname: Wagner
authors.forename: J R
authors.initials: JR
authors.lastname: Grandis
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery*; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D010878:Piperacillin / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000517:prevention & control*; D000078142:Tazobactam; D007507:Therapeutic Irrigation
chemical_list: D009067:Mouthwashes; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin