title: Surgical Site Infections in Patients Receiving Osteomyocutaneous Free Flaps to the Head and Neck. Does Choice of Antibiotic Prophylaxis Matter?
abstract: OBJECTIVE
  The most appropriate prophylactic antibiotic for clean-and-contaminated head and neck osteomyocutaneous free flap (OFF) tissue transfer procedures is unclear. The purpose of this study was to determine whether the choice of perioperative antibiotic was related to recipient surgical site infection (SSI) in patients receiving an OFF to the head and neck.
  
  
  METHODS
  This retrospective cohort study evaluated SSI in relation to the perioperative antibiotic received from July 2010 through October 2013 at a tertiary care medical center. Minimum follow-up was 6 months. SSI was defined by the Centers for Disease Control and Prevention wound infection criteria. Perioperative antibiotic selected, duration of use, OFF performed, medical comorbidities, and SSIs were recorded and analyzed.
  
  
  RESULTS
  One hundred two patients (64 men, 38 women) met the inclusion criteria. Forty patients developed an SSI. Analysis of variance showed that age (P = .64), gender (P = .97), use of alcohol (P = .87), final pathology (P = .3), cardiovascular disease (P = .33), and diabetes mellitus or immune dysfunction (P = .95) did not have a significant association with the development of a postoperative wound infection. On univariate analysis, non-head and neck primary malignancies showed a significant risk for SSI (P = .03), with previous head and neck surgery (P = .05) and oral tobacco use (P = .06) having trends for increased risk of SSI. Clindamycin antibiotic was strongly associated with the development of an SSI, with 50% of that cohort developing a recipient SSI (odds ratio = 7.0; P < .002), regardless of duration of use. The rate of development of a recipient SSI with cefazolin was 25% and that with ampicillin plus sulbactam was 19%.
  
  
  CONCLUSIONS
  A statistically relevant number of patients who developed a recipient SSI received clindamycin as perioperative antibiotic prophylaxis. An antibiotic regime other than clindamycin should be considered in patients with an allergy to penicillin or cephalosporin who are undergoing an OFF procedure to the head and neck.
authors.affiliation: Former Resident, Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD.
authors.forename: James
authors.initials: J
authors.lastname: Murphy
authors.affiliation: Assistant Professor, Department of Otorhinolaryngology Head and Neck Surgery, University of Maryland, Baltimore, MD.
authors.forename: Amal
authors.initials: A
authors.lastname: Isaiah
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD.
authors.forename: Donita
authors.initials: D
authors.lastname: Dyalram
authors.affiliation: Associate Professor and Fellowship Program Director, Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD. Electronic address: jlubek@umaryland.edu.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Lubek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D016025:Bone Transplantation; D015331:Cohort Studies; D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D055815:Young Adult