title: Increased Surgical Site Infection Rates following Clindamycin Use in Head and Neck Free Tissue Transfer.
abstract: OBJECTIVE
  The development of surgical site infections (SSIs) can put the viability of free tissue transfer reconstructions at risk, often resulting in considerable postoperative morbidity and prolonged hospitalization. Current antibiotic prophylactic guidelines suggest a first- or second-generation cephalosporin with metronidazole for clean-contaminated cases and recommend clindamycin as an alternative choice in penicillin-allergic patients. This study was designed to examine the rates of postoperative infection associated with prophylactic antibiotic regimens, including patients receiving clindamycin as an alternative due to penicillin allergy.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  Patients undergoing major ablative head and neck resection involving the pharynx and oral cavity reconstructed via free tissue transfer.
  
  
  METHODS
  The sample included patients (n = 266) who underwent free tissue transfer involving the oral cavity and pharynx from 2009 to 2014. Data included demographic data, medical comorbidities, anatomic tumor subsite and surgical procedure, and prophylactic antibiotic regimen. SSI data were examined up to 30 days after the initial surgical procedure. Multivariate logistic regression analysis was performed to determine the overall risk for SSI. Culture data were also reviewed.
  
  
  RESULTS
  The data indicated that clindamycin was associated with an approximate 4-fold increased risk for SSI (odds ratio, 3.784; 95% confidence interval: 1.367-10.470 [P = .010]) after controlling for possible confounding factors.
  
  
  CONCLUSIONS
  For patients with a true penicillin allergy, we recommend broader gram-negative coverage with alternative antibiotics, such as cefuroxime, when undergoing free tissue transfer in the head and neck.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Pool
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Kass
authors.affiliation: Department of Population Health Science and Policy, Icahn Medical Institute, New York, New York, USA.
authors.forename: John
authors.initials: J
authors.lastname: Spivack
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Nadav
authors.initials: N
authors.lastname: Nahumi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Mohemmed
authors.initials: M
authors.lastname: Khan
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Lenard
authors.initials: L
authors.lastname: Babus
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Marita S
authors.initials: MS
authors.lastname: Teng
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Genden
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA brett.miles@mountsinai.org.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Miles
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D002981:Clindamycin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin
keywords: antibiotic prophylaxis; free tissue transfer; head and neck cancer; surgical site infection