Surgical side infections of the tracheostomy - A retrospective cohort study of patients with head and neck cancer in intensive care.

This study was conducted to reveal the relevant risk factors for surgical site infections (SSI) of the tracheostomy in ICU tracheostomy patients with oncologic history. Retrospectively, medical and ICU records of patients who received open tracheostomy in a uniform manner were investigated. Of 187 consecutive patients in total, patients with a peri/post-operative antibiotic prophylaxis (POABP) experienced significantly more Organ-Space SSI, whereas patients with a POABP developed less Superficial Incisional SSI and Deep Incisional SSI. Neck Dissection (p = 0.025), especially the more levels are included, and POABP (p = 0.005) have a significant impact on the occurrence of an SSI of the tracheostomy. Deep incisional SSI significantly prolonged a patient's dependency on a ventilator (p = 0.045, M = 3.92, SD = 4.718). The difference between Superficial Incisional, Deep Incisional and Organ-Space SSI should be taken in consideration regarding risk evaluation and treatment. Furthermore, a gram-negative facultative anaerobic biofilm should be taken into consideration in treatment options and thus an escalation regarding antibiotic treatment as a POABP. For fulminant SSI of the tracheostomy the use of piperacillin/tazobactam or 3rd generation cephalosporines or carbapenems is recommendable.