DALLAS — Patients undergoing complex facial flap reconstruction for cancer or other reasons could have their risk of surgical site infections (SSIs) reduced if treated with common topical antisepsis agents prior to surgery, a multi-institutional cohort study suggested.
In the prospective study of over 500 patients undergoing upper aerodigestive tract reconstruction, multivariable analysis showed that preoperative topical antisepsis mucosal preparation was associated with a 51% decreased risk of postoperative SSIs (OR 0.49, 95% CI 0.30-0.77), reported Ahmed Beydoun, MD, of the Medical College of Wisconsin in Milwaukee.
This benefit was similar to the 58% reduction in SSI risk with the systemic antibiotics piperacillin and tazobactam given prophylactically (OR 0.42, 95% CI 0.21-0.84), according to findings presented during a “Best of the Abstracts” session at the annual meeting of the American Head and Neck Society (AHNS).
The only other independent factor linked to SSIs was the use of an osseous vascularized flap (OR 1.76, 95% CI 1.13-2.75), the researchers found.
“Surgical site infections remain a major source of morbidity for patients undergoing flap reconstruction of UADT [upper aerodigestive tract reconstruction] defects,” wrote Beydoun and co-authors in JAMA Otolaryngology – Head & Neck Surgery, where the findings were published simultaneously.
“The results of this cohort study suggest a role for preoperative topical antisepsis mucosal preparation in reducing rates of SSI,” the group added. “Our findings also support the high prevalence of pathogenic gram-negative bacilli and consideration of greater gram-negative coverage with perioperative prophylaxis.”
Randomized trials are needed to evaluate individual topical and systemic prophylactic interventions for SSI risk in this patient population, the group concluded.
“We don’t routinely use topical antisepsis now with patients undergoing flap procedures,” said AHNS session co-chair Nicole Schmitt, MD, of Emory University in Atlanta. “However,” she told MedPage Today, “I think I will share this information with my partners and we might start doing that. While there are studies that indicate that there may not be an advantage, I think there is very little downside. It costs like $5 to use this, so why not give it a try?”
To perform their trial, Beydoun and colleagues enrolled 554 patients from 12 academic medical centers in the U.S. from July 2020 to June 2021.
The median age was 64 years, most of the patients (86.6%) were being treated for cancer ablation, and the overall incidence of SSIs was 21% (116 patients). Most infections involved the head and neck surgical site only (91 of the patients). Mean time to SSI diagnosis was 11 days.
Topical mucosal antisepsis was used preoperatively in 35% of cases and postoperatively in 52% of cases, while intraoperative antiseptic irrigations were performed in 11% of cases. The most frequent topical antisepsis used preoperatively — on the day of surgery prior to incision — was povidone-iodine alone, about half the time, while chlorhexidine alone or both agents together were used in the other cases.
Systemic antibiotic prophylaxis choices and duration varied: the most common choice was ampicillin/sulbactam (66% of cases), followed by piperacillin/tazobactam (15%), cefazolin (6%), cefazolin/metronidazole (5.6%), and clindamycin (3.2%).
About two-thirds of the prophylactic antibiotic use was for 24 hours while about 17.5% were treated with antibiotics for 48 hours, and rest were treated for as long as a week.
Beydoun disclosed no relationships with industry.
Schmitt disclosed relationships with Sensorian, Checkpoint Surgical, and Astex Pharmaceuticals.