Antibiotic prophylaxis in clean-contaminated head and neck cases with microvascular free flap reconstruction: A systematic review and meta-analysis

作者：Haidar Yarah M.^*; Tripathi Prem B.; Tjoa Tjoson; Walia Sartaaj; Zhang Lishi; Chen Yanjun; Nguyen Danh V.; Mahboubi Hossein; Armstrong William B.; Goddard Julie A.

来源：Head and Neck-Journal for the Sciences and Specialties of the Head and Neck, 2018, 40(2): 417-427.

DOI：10.1002/hed.24988

• clean-contaminated
• free flaps
• microvascular surgery
• prophylactic antibiotics
• surgical site infection

Background: Optimal antibiotic prophylaxis duration in head and neck clean-contaminated free-flap cases is unknown.
Methods: A systematic review/meta-analysis was conducted using PubMed/MEDLINE, Cochrane Library, Web-of-Science, and Scopus databases.
Results: Of the 3755 searched articles, 5 articles were included for a total of 861 patients. The recipient surgical site infection risk was significantly higher in patients receiving prophylactic antibiotics for <= 24 hours compared to >24 hours (relative risk [RR] 1.56; 95% confidence interval [CI] 1.13-2.14). In the post hoc multivariate analysis based on available individual-level data on 697 patients from 3 studies, the risk of surgical site infection for <= 24 hours versus >24 hours was not significant after adjusting for antibiotic type (RR 1.09; 95% CI 0.78-1.55). When compared to ampicillin-sulbactam, patients who received clindamycin prophylaxis had an increased likelihood of recipient surgical site infection (RR 2.85; 95% CI 1.95-4.17).
Conclusion: Less than or equal to 24 hours of antibiotic prophylaxis in head and neck clean-contaminated free-flap is likely sufficient but a strong conclusion remains elusive. Clindamycin prophylaxis increases the risk of recipient surgical site infection. Further prospective trials are necessary to clarify.

• 出版日期2018-2