Post-operative wound infection in salvage laryngectomy: Does antibiotic prophylaxis have an impact?

William Scotton*, Richard Cobb, Leo Pang, Iain Nixon, Anil Joshi, Jeanne Pierre Jeannon, Richard Oakley, Gary French, Carolyn Hemsley, Ricard Simo

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Salvage laryngectomy carries a high risk of postoperative infection with reported rates of 40-61%. The purpose of this studywas to analyse infections in our own patients and review the potential impact of our current antibiotic prophylaxis (AP). A retrospective analysis of infection in 26 consecutive patients between 2000 and 2010 undergoing salvage total laryngectomy (SL) following recurrent laryngeal cancer after failed radiotherapy or chemo-radiation was undertaken. The antibiotic prophylaxis was intravenous teicoplanin, cefuroxime and metronidazole at induction and for the following 24 h. Infection was defined by Tabet and Johnson's grade 5, categorized as pharyngocutaneous fistula. Fifteen patients (58%) developed a post-operative wound infection, which occurred on average at 12 days after surgery. Univariate analysis demonstrated three risk variables that had a significant correlation with infection: alcohol consumption (p = 0.01), cN stage of tumour (p<0.01), and pre-operative albumin levels <3.2 g/L (p = 0.012). There was a trend, though not significant, for increased infection in patients with high or lowBMIs. Themost common organisms isolated from clinical samples from infected patients were methicillinresistant Staphylococcus aureusMRSA(43%), Pseudomonas aeruginosa (36%), Serratia marcescens, Proteus mirabilis and Enterococcus faecalis (7%each).All these organisms are typical hospital-acquired pathogens. Pseudomonas and Serratia were not covered by the prophylactic regime we used. The current antibiotic regime following SL is inadequate as the rate of infection is high. It would therefore seemlogical to trial a separate antibiotic protocol of AP for patients undergoing SL thatwould include an extended course of antibiotics after the standard prophylaxis. In addition, infection ratesmay also be reduced by improving the metabolic state of patients pre-operatively bymulti-disciplinary action. Steps should also be taken to reduce cross-infection with nosocomial pathogens in these patients. Other aspects of surgical management should be also taken in consideration.

Original languageEnglish
Pages (from-to)2415-2422
Number of pages8
JournalEuropean Archives of Oto-Rhino-Laryngology
Volume269
Issue number11
DOIs
Publication statusPublished - 1 Nov 2012

Keywords

  • Antibiotic prophylaxis
  • Chemotherapy
  • Laryngeal carcinoma
  • Laryngectomy
  • Pharyngocutaneous fistulae
  • Radiotherapy

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