The time course and microbiology of surgical site infections after head and neck free flap surgery

Objectives/Hypothesis Determine the time of onset and microbiology of surgical site infections (SSIs) following head and neck free flap reconstructive surgeries. Study Design Retrospective cohort study. Methods All 504 free flap surgical cases (484 patients) performed April 1, 2009 to September 30,...

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Published in:The Laryngoscope 2015-05, Vol.125 (5), p.1084-1089
Main Authors: Durand, Marlene L., Yarlagadda, Bharat B., Rich, Debbie L., Lin, Derrick T., Emerick, Kevin S., Rocco, James W., Deschler, Daniel G.
Format: Article
Language:English
Subjects:
Antibiotic Prophylaxis - methods
Bacteria - isolation & purification
complications
Follow-Up Studies
free flap
Free Tissue Flaps
head and neck cancer
Head and Neck Neoplasms - surgery
Humans
Incidence
Massachusetts - epidemiology
Medical research
Microbiology
reconstructive surgery
Reconstructive Surgical Procedures - adverse effects
Reconstructive Surgical Procedures - methods
Retrospective Studies
Risk Assessment
Staphylococcus infections
Surgical site infection
Surgical Wound Infection - epidemiology
Surgical Wound Infection - microbiology
Surgical Wound Infection - prevention & control
Time Factors
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Summary:Objectives/Hypothesis Determine the time of onset and microbiology of surgical site infections (SSIs) following head and neck free flap reconstructive surgeries. Study Design Retrospective cohort study. Methods All 504 free flap surgical cases (484 patients) performed April 1, 2009 to September 30, 2013 were reviewed; SSIs occurring ≤30 days postoperatively were evaluated. Admission screening for methicillin‐resistant Staphylococcus aureus (MRSA) colonization was performed on all patients. Results Flap‐recipient site infections (flap SSIs) occurred in 67 cases (13.3%), one‐third week 1 postoperatively, one‐third week 2, one‐third days 15 to 30; 45% occurred after hospital discharge. Wound cultures were polymicrobial, but 25% grew only normal oral flora, whereas 75% grew pathogens not part of normal oral flora, such as gram‐negative bacilli (44% of cases), MRSA (20%), and methicillin‐sensitive S aureus (MSSA) (16%). The frequency of these pathogens did not vary significantly by the time of SSI onset. In 67%, cultures included at least one pathogen resistant to the prophylactic antibiotic used. Clindamycin prophylaxis was a significant risk factor for flap SSI and for early partial or complete flap loss from infection. Donor SSIs occurred in 22 cases (4.4%), 95% >1 week postoperatively, and MRSA or MSSA were the primary pathogens in 89%. Of the 25 patients colonized with MRSA on admission, 40% developed a flap or donor SSI, a rate significantly higher than in non‐colonized patients. Conclusions Gram‐negative bacilli, MRSA, and MSSA were significant SSI pathogens, and late onset of infection was common. Better screening, decolonization, and prophylaxis may reduce SSI rates. Level of Evidence 2b Laryngoscope, 125:1084–1089, 2015
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.25038