Head & neck · 2026
Perioperative Piperacillin/Tazobactam Reduces Early Onset SSI in Preirradiated Patients Undergoing Microvascular Head and Neck Reconstruction.
СтатьяНазвание и аннотация: Перевод в очереди
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Schuderer Johannes G, Hoferer Florian, Eichberger Jonas, Fiedler Mathias, Gessner André, Bauernfeind Stilla, Gottsauner Maximilian, Nieberle Felix, Maurer Michael, Meier Johannes K, Reichert Torsten E, Ettl Tobias
Аннотация
BACKGROUND: Preirradiated patients undergoing microvascular head and neck reconstruction for tumor recurrence or osteoradionecrosis (ORN) face surgical site infection (SSI) rates exceeding 30%. The impact of perioperative extended-spectrum antibiotic coverage remains unclear. This study hypothesizes that calculated prophylaxis with piperacillin/tazobactam reduces early-onset SSI in this high-risk population.
METHODS: From a microvascular reconstructed cohort, 161 with prior irradiation were retrospectively identified (tumor, N = 101; ORN, N = 60). SSI risk reduction was compared between patients receiving piperacillin/tazobactam (N = 39) and standard prophylaxis (N = 122).
RESULTS: With underlying SSI incidence of 36%, piperacillin/tazobactam showed a fourfold SSI risk reduction (HR 0.24; p = 0.002) across the entire cohort and a fivefold reduction in patients with bone resection (HR 0.17; p = 0.01). Subgroup analyses confirmed this effect with a sevenfold reduction in tumor patients (HR 0.14; p = 0.008) and a threefold reduction in ORN patients (HR 0.29; p = 0.04). Extended coverage did not significantly prolong antibiotic treatment times.
CONCLUSION: In summary, calculated use of piperacillin/tazobactam in previously irradiated patients requiring microvascular reconstruction appears effective in reducing early-onset SSI.
METHODS: From a microvascular reconstructed cohort, 161 with prior irradiation were retrospectively identified (tumor, N = 101; ORN, N = 60). SSI risk reduction was compared between patients receiving piperacillin/tazobactam (N = 39) and standard prophylaxis (N = 122).
RESULTS: With underlying SSI incidence of 36%, piperacillin/tazobactam showed a fourfold SSI risk reduction (HR 0.24; p = 0.002) across the entire cohort and a fivefold reduction in patients with bone resection (HR 0.17; p = 0.01). Subgroup analyses confirmed this effect with a sevenfold reduction in tumor patients (HR 0.14; p = 0.008) and a threefold reduction in ORN patients (HR 0.29; p = 0.04). Extended coverage did not significantly prolong antibiotic treatment times.
CONCLUSION: In summary, calculated use of piperacillin/tazobactam in previously irradiated patients requiring microvascular reconstruction appears effective in reducing early-onset SSI.