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


ABSTRACT: 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.

SUBMITTER: Haidar YM 

PROVIDER: S-EPMC6489503 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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

Haidar Yarah M YM   Tripathi Prem B PB   Tjoa Tjoson T   Walia Sartaaj S   Zhang Lishi L   Chen Yanjun Y   Nguyen Danh V DV   Mahboubi Hossein H   Armstrong William B WB   Goddard Julie A JA  

Head & neck 20171030 2


<h4>Background</h4>Optimal antibiotic prophylaxis duration in head and neck clean-contaminated free-flap cases is unknown.<h4>Methods</h4>A systematic review/meta-analysis was conducted using PubMed/MEDLINE, Cochrane Library, Web-of-Science, and Scopus databases.<h4>Results</h4>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 compare  ...[more]

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