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Antibiotics in head and neck surgery in the setting of malnutrition, tracheotomy, and diabetes

Ali Sepehr, Barbara-Jean Gutierrez Santos, Chinsui Chou, Koohyar Karimi, Zlatko Devcic, Stefanie Oels, William B Armstrong
Laryngoscope 2009, 119 (3): 549-53

OBJECTIVES/HYPOTHESIS: The objectives of this study are to compare short vs. long antibiotic prophylaxis in the setting of malnutrition, diabetes, and tracheotomy.

STUDY DESIGN: Retrospective chart review.

METHODS: The charts of 407 patients undergoing clean-contaminated head and neck surgery were reviewed for disease type, operation performed, length of antibiotic prophylaxis, wound complications, and length of hospital stay. Three intrinsic patient risk factors for infection (malnutrition, diabetes mellitus, and tracheotomy) were evaluated for an effect on the optimal length of antibiotic prophylaxis. The data was statistically analyzed using the two-tailed Fisher's exact test.

RESULTS: Overall, the incidence of infection was 7% in short-course antibiotics and 13% in long-course antibiotics (P = .06). The incidence of infection was 18% in malnourished patients and 3% in well-nourished patients (P < .0001). In malnourished patients, the incidence of infection was 16% in short-course antibiotics and 19% in long-course antibiotics (P = 1). The incidence of infection was 11% in diabetics and 23% in nondiabetics (P = .13). In diabetic patients, the incidence of infection was 0% on short-course antibiotics and 16% on long-course antibiotics (P = .55). The incidence of pneumonia was 14% in patients with tracheotomy and 5% in patients without tracheotomy (P = .0014). In patients with tracheotomy, the incidence of pneumonia was 8% on short-course antibiotics and 15% on long-course antibiotics (P = .6931).

CONCLUSIONS: Malnutrition and tracheotomy were associated with a higher infection rate while diabetes was not found to be a risk factor. Prolonged antibiotics were not associated with a lower infection rate in the overall group or in any subgroup.

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