Pneumonia, urinary tract infection, bacteremia, and Clostridioides difficile infection following major head and neck free and pedicled flap surgeries

Objectives: Medical postoperative infections (MPIs) are important causes of morbidity following major head and neck free and pedicled flap reconstruction, but the incidence, time of onset, and microbiology are not well characterized. Materials and methods: Medical records were reviewed of all head and neck flap surgeries performed 2009–2014 at an academic medical center. Postoperative pneumonia, urinary tract infection (UTI), bloodstream infection (BSI), Clostridioides difficile (CDI), and surgical site infections (SSI) were noted. Catheter-associated UTI (CAUTI), central line-associated BSI (CLABSI), and methicillin-resistant Staphylococcus aureus (MRSA) BSI were also evaluated. Results: Following 715 free (5 4 0) or pedicled (1 7 5) flap surgeries, 14.1% of patients developed ≥one MPI including pneumonia (10.6%), UTI (2.1%), BSI (0.7%), and CDI (2.4%). Onset was ≤7 days in 77%. The MPI incidence in free vs pedicled flaps was similar. By multivariate analysis, age ≥65 and clindamycin perioperative prophylaxis were associated with increased MPI risk, clean class surgery with decreased risk. The incidence of CAUTI (<1.0%), CLABSI (0.1%), and hospital-onset MRSA BSI (0.1%) was low. SSI rate (7.8% overall) was higher in patients who developed pneumonia (18.4 vs 6.6, p = 0.004). MPI cultures grew gram-negative bacilli or S. aureus in 75%. The length of stay was longer in patients who developed a MPI than those who did not (17.4 vs 10.4 days, p < 0.0001). Conclusions: One-seventh of major head and neck flap surgeries were complicated by MPIs, three-quarters of infections developed within 1 week postoperatively. Gram-negative bacilli and S. aureus were the predominant pathogens.

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Work Title Pneumonia, urinary tract infection, bacteremia, and Clostridioides difficile infection following major head and neck free and pedicled flap surgeries
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Open Access
Creators
  1. Tjoson Tjoa
  2. Vinay K. Rathi
  3. Neerav Goyal
  4. Bharat B. Yarlagadda
  5. Miriam B. Barshak
  6. Debbie L. Rich
  7. Kevin S. Emerick
  8. Derrick T. Lin
  9. Daniel G. Deschler
  10. Marlene L. Durand
Keyword
  1. Postoperative pneumonia
  2. Urinary tract infection
  3. Catheter-associated urinary tract infection
  4. Bacteremia
  5. Bloodstream infection
  6. Clostridioides difficile infection
  7. Pedicled flap
  8. Free flap
  9. Healthcare-associated infection
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Oral Oncology
Publication Date September 23, 2021
Publisher Identifier (DOI)
  1. https://doi.org/10.1016/j.oraloncology.2021.105541
Deposited November 08, 2024

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Version 1
published

  • Created
  • Added Pneumonia-Urinary-tract-bacteremia-clostridioides.pdf
  • Added Creator Tjoson Tjoa
  • Added Creator Vinay K. Rathi
  • Added Creator Neerav Goyal
  • Added Creator Bharat B. Yarlagadda
  • Added Creator Miriam B. Barshak
  • Added Creator Debbie L. Rich
  • Added Creator Kevin S. Emerick
  • Added Creator Derrick T. Lin
  • Added Creator Daniel G. Deschler
  • Added Creator Marlene L. Durand
  • Published
  • Updated
  • Updated Keyword, Publication Date Show Changes
    Keyword
    • Postoperative pneumonia , Urinary tract infection , Catheter-associated urinary tract infection , Bacteremia , Bloodstream infection , Clostridioides difficile infection , Pedicled flap , Free flap , Healthcare-associated infection
    Publication Date
    • 2021-11-01
    • 2021-09-23
  • Updated Publisher's Statement Show Changes
    Publisher's Statement
    • Objectives: Medical postoperative infections (MPIs) are important causes of morbidity following major head and
    • neck free and pedicled flap reconstruction, but the incidence, time of onset, and microbiology are not well
    • characterized.
    • Materials and methods: Medical records were reviewed of all head and neck flap surgeries performed 2009–2014
    • at an academic medical center. Postoperative pneumonia, urinary tract infection (UTI), bloodstream infection
    • (BSI), Clostridioides difficile (CDI), and surgical site infections (SSI) were noted. Catheter-associated UTI (CAUTI),
    • central line-associated BSI (CLABSI), and methicillin-resistant Staphylococcus aureus (MRSA) BSI were also
    • evaluated.
    • Results: Following 715 free (540) or pedicled (175) flap surgeries, 14.1% of patients developed ≥one MPI
    • including pneumonia (10.6%), UTI (2.1%), BSI (0.7%), and CDI (2.4%). Onset was ≤7 days in 77%. The MPI
    • incidence in free vs pedicled flaps was similar. By multivariate analysis, age ≥65 and clindamycin perioperative
    • prophylaxis were associated with increased MPI risk, clean class surgery with decreased risk. The incidence of
    • CAUTI (<1.0%), CLABSI (0.1%), and hospital-onset MRSA BSI (0.1%) was low. SSI rate (7.8% overall) was
    • higher in patients who developed pneumonia (18.4 vs 6.6, p = 0.004). MPI cultures grew gram-negative bacilli or
    • S. aureus in 75%. The length of stay was longer in patients who developed a MPI than those who did not (17.4 vs
    • 10.4 days, p < 0.0001).
    • Conclusions: One-seventh of major head and neck flap surgeries were complicated by MPIs, three-quarters of
    • infections developed within 1 week postoperatively. Gram-negative bacilli and S. aureus were the predominant
    • pathogens.