Antibiotics in head and neck surgery in the setting of malnutrition, tracheotomy, and diabetes.
OBJECTIVE
The objectives of this study are to compare short vs. long antibiotic prophylaxis in the setting of malnutrition, diabetes, and tracheotomy.


METHODS
Retrospective chart review.


METHODS
The charts of 407 patients undergoing clean-contaminated head and neck surgery were reviewed for disease type, operation performed, length of antibiotic prophylaxis, wound complications, and length of hospital stay. Three intrinsic patient risk factors for infection (malnutrition, diabetes mellitus, and tracheotomy) were evaluated for an effect on the optimal length of antibiotic prophylaxis. The data was statistically analyzed using the two-tailed Fisher's exact test.


RESULTS
Overall, the incidence of infection was 7% in short-course antibiotics and 13% in long-course antibiotics (P = .06). The incidence of infection was 18% in malnourished patients and 3% in well-nourished patients (P < .0001). In malnourished patients, the incidence of infection was 16% in short-course antibiotics and 19% in long-course antibiotics (P = 1). The incidence of infection was 11% in diabetics and 23% in nondiabetics (P = .13). In diabetic patients, the incidence of infection was 0% on short-course antibiotics and 16% on long-course antibiotics (P = .55). The incidence of pneumonia was 14% in patients with tracheotomy and 5% in patients without tracheotomy (P = .0014). In patients with tracheotomy, the incidence of pneumonia was 8% on short-course antibiotics and 15% on long-course antibiotics (P = .6931).


CONCLUSIONS
Malnutrition and tracheotomy were associated with a higher infection rate while diabetes was not found to be a risk factor. Prolonged antibiotics were not associated with a lower infection rate in the overall group or in any subgroup.
Sepehr
Ali
A
University of California Irvine School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Orange, California.
Santos
Barbara-Jean Gutierrez
BJ
Chou
Chinsui
C
Karimi
Koohyar
K
Devcic
Zlatko
Z
Oels
Stefanie
S
Armstrong
William B
WB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D048909:Diabetes Complications / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000150:complications / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents