title: Extended use of perioperative antibiotics in head and neck microvascular reconstruction.
abstract: OBJECTIVE
  Many head and neck surgical procedures are considered clean-contaminated wounds and antibiotic prophylaxis is recommended. Despite prophylaxis, the incidence of surgical site infections remains significant - especially in the setting of free tissue transfer. The antibiotic course is often of a longer duration after free tissue transfer than the recommended 24hour post-operatively. Currently, there is no consensus on appropriate antibiotic regimen or duration at this time. This study investigates the outcomes of a 7-day perioperative antibiotic regimen after microvascular reconstruction of the head and neck at our institution.
  
  
  METHODS
  A retrospective review was performed of 72 patients undergoing microvascular free tissue at our institution between 09/2011 and 03/2014. The antibiotic regimen, post-operative surgical (including surgical site infections) and medical complications were noted. Our rates of complications and adverse events were compared to all surgical patients, as well as all inpatients hospital-wide with use of the University Health System Consortium database.
  
  
  RESULTS
  Seventy-two subjects met inclusion criteria for this study. The majority of subjects received cefazolin/metronidazole (69.4%). Subjects with beta-lactam allergy received clindamycin (12.5%). The remainder received an alternative regimen (18.1%). All received at least 7days of antibiotics. The rate of hospital acquired C. difficile diarrhea was 0.57% hospital-wide, 1.13% in Otolaryngology patients, and 1.4% in this study. There were no instances of a multi-drug resistant infection or any adverse reactions to the administration of antibiotics. When compared with other antibiotic regimens, clindamycin was associated with a significantly increased rate of either medical or surgical infections (OR 14.38, p=0.02) and longer hospital stay (average=18days, p<0.05).
  
  
  CONCLUSIONS
  The use of a 7-day prophylactic antibiotic regimen is not associated with an increased risk of antibiotic-associated infections, multi-drug resistant infections, or antibiotic-associated complications. The use of clindamycin is associated with increased risk of medical and surgical infections post-operatively and should be avoided in the prophylactic perioperative phase after free tissue transfer of the head and neck.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Saunders
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Reese
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Lam
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Wulu
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Scharkuh
authors.initials: S
authors.lastname: Jalisi
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA. Electronic address: ezzatmd@gmail.com.
authors.forename: Waleed
authors.initials: W
authors.lastname: Ezzat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*
keywords: Antibiotic prophylaxis; Free tissue transfer; Head and neck; Microvascular