Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
Department of Otolaryngology, Penn State Milton S. Hershey Medical Center, 200 Campus Drive, Hershey, PA 17033, United States.
Oral Oncol. 2021 Nov;122:105541. doi: 10.1016/j.oraloncology.2021.105541. Epub 2021 Sep 23.
Medical postoperative infections (MPIs) are important causes of morbidity following major head and neck free and pedicled flap reconstruction, but the incidence, time of onset, and microbiology are not well characterized.
Medical records were reviewed of all head and neck flap surgeries performed 2009-2014 at an academic medical center. Postoperative pneumonia, urinary tract infection (UTI), bloodstream infection (BSI), Clostridioides difficile (CDI), and surgical site infections (SSI) were noted. Catheter-associated UTI (CAUTI), central line-associated BSI (CLABSI), and methicillin-resistant Staphylococcus aureus (MRSA) BSI were also evaluated.
Following 715 free (540) or pedicled (175) flap surgeries, 14.1% of patients developed ≥one MPI including pneumonia (10.6%), UTI (2.1%), BSI (0.7%), and CDI (2.4%). Onset was ≤7 days in 77%. The MPI incidence in free vs pedicled flaps was similar. By multivariate analysis, age ≥65 and clindamycin perioperative prophylaxis were associated with increased MPI risk, clean class surgery with decreased risk. The incidence of CAUTI (<1.0%), CLABSI (0.1%), and hospital-onset MRSA BSI (0.1%) was low. SSI rate (7.8% overall) was higher in patients who developed pneumonia (18.4 vs 6.6, p = 0.004). MPI cultures grew gram-negative bacilli or S. aureus in 75%. The length of stay was longer in patients who developed a MPI than those who did not (17.4 vs 10.4 days, p < 0.0001).
One-seventh of major head and neck flap surgeries were complicated by MPIs, three-quarters of infections developed within 1 week postoperatively. Gram-negative bacilli and S. aureus were the predominant pathogens.
医学术后感染（MPIs）是头颈部游离和带蒂皮瓣重建术后发病率的重要原因，但发病率、发病时间和微生物学尚未得到很好的描述。
回顾了 2009 年至 2014 年在一所学术医疗中心进行的所有头颈部皮瓣手术的病历。记录了术后肺炎、尿路感染（UTI）、血流感染（BSI）、艰难梭菌（CDI）和手术部位感染（SSI）。还评估了导管相关性尿路感染（CAUTI）、中心静脉相关 BSI（CLABSI）和耐甲氧西林金黄色葡萄球菌（MRSA）BSI。
在 715 例游离（540 例）或带蒂（175 例）皮瓣手术后，14.1%的患者发生了≥1 种 MPI，包括肺炎（10.6%）、UTI（2.1%）、BSI（0.7%）和 CDI（2.4%）。77%的感染在≤7 天内发生。游离皮瓣与带蒂皮瓣的 MPI 发生率相似。多变量分析显示，年龄≥65 岁和围手术期克林霉素预防与 MPI 风险增加相关，清洁级手术与风险降低相关。CAUTI（<1.0%）、CLABSI（0.1%）和医院获得性 MRSA BSI（0.1%）的发生率较低。发生肺炎的患者 SSI 发生率（18.4%，6.6%，p=0.004）较高。MPI 培养物中生长的革兰氏阴性杆菌或金黄色葡萄球菌占 75%。发生 MPI 的患者的住院时间长于未发生 MPI 的患者（17.4 天比 10.4 天，p<0.0001）。
头颈部游离和带蒂皮瓣重建术的 1/7 例发生 MPI，75%的感染发生在术后 1 周内。革兰氏阴性杆菌和金黄色葡萄球菌是主要病原体。
