Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany.
Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany.
J Craniomaxillofac Surg. 2022 Feb;50(2):178-187. doi: 10.1016/j.jcms.2021.11.002. Epub 2021 Nov 16.
The aim of this study was to identify risk factors for surgical (SSI) and remote site (RSI) infections, pathogens and antibiotic resistances in patients after pedicled and free flap reconstruction in the head and neck area. SSI criteria implicated infections affecting superficial or deep tissue in the flap area with purulent discharge, fistula, abscess formation and local infections signs. RSI criteria were defined as infections remote from the surgical site presenting with systemic symptoms like fever, leucocytosis, increase in C-reactive protein, purulent tracheobronchial secretion or deterioration of blood gases. Focus adequate specimen sampling and aerobic and anaerobic incubation and cultivation was performed. Epidemiological data, factors directly related to surgery or reconstruction, perioperative antibiotic regimen, length of stay, autologous blood transfusion and microbiological aspects were retrospectively analysed in 157 patients. 10.8% of patients presented SSI, 12.7% RSI. Cultivated bacteria were sampled from flap sites, blood cultures, central catheters and sputum including mainly gram-negative bacteria (70.3%) being frequently resistant against penicillin (85%) and third generation cephalosporine derivates (48%). Autologous blood transfusion (p = 0.018) and perioperative clindamycin use (p = 0.002) were independent risk factors for overall (SSI and RSI combined) infections. Prior radiation (p = 0.05), autologous blood transfusion (p = 0.034) and perioperative clindamycin use (p = 0.004) were predictors for SSIs. ASA >2 (p = 0.05) was a risk factor for remote site infections and prolonged ICU stay (p = 0.002) was associated with overall infections, especially in irradiated patients. Efforts need to be made in improving patient blood management, antibiotic stewardship and accurate postoperative care to avoid postoperative infections after head and neck reconstructive surgery.
本研究旨在确定头颈部带蒂和游离皮瓣重建术后患者手术部位（SSI）和远处部位（RSI）感染、病原体和抗生素耐药的危险因素。SSI 标准包括影响皮瓣区域浅表或深部组织的感染，伴有脓性分泌物、瘘管、脓肿形成和局部感染迹象。RSI 标准定义为远离手术部位的感染，表现为全身症状，如发热、白细胞增多、C 反应蛋白升高、脓性气管支气管分泌物或血气恶化。对适当的标本进行了采样，并进行了需氧和厌氧孵育和培养。回顾性分析了 157 例患者的流行病学数据、与手术或重建直接相关的因素、围手术期抗生素方案、住院时间、自体输血和微生物学方面。10.8%的患者出现 SSI，12.7%的患者出现 RSI。从皮瓣部位、血培养、中心导管和痰中采样培养细菌，包括主要革兰氏阴性菌（70.3%），对青霉素（85%）和第三代头孢菌素衍生物（48%）经常耐药。自体输血（p=0.018）和围手术期克林霉素使用（p=0.002）是总体（SSI 和 RSI 合并）感染的独立危险因素。既往放疗（p=0.05）、自体输血（p=0.034）和围手术期克林霉素使用（p=0.004）是 SSI 的预测因素。ASA >2（p=0.05）是远处部位感染的危险因素，而 ICU 住院时间延长（p=0.002）与总体感染相关，尤其是在接受放疗的患者中。需要努力改善患者血液管理、抗生素管理和术后护理，以避免头颈部重建术后发生术后感染。
