(HealthDay News) — For patients undergoing head and neck free flap reconstruction, the choice of antibiotic impacts postoperative infection rate, according to a study published online April 23 in JAMA Otolaryngology-Head & Neck Surgery.

Ryan M. Mitchell, MD, PhD, from the University of Washington in Seattle, and colleagues conducted a retrospective cohort study involving 427 adults receiving free flap reconstruction of head and neck defects. The authors examined prophylactic antibiotic type and duration among the cohort.

The researchers found that 22.5 and 77.5% of patients received prophylactic antibiotics for ≤24 hours or prolonged courses of prophylactic antibiotics, respectively. Overall, 53.2, 36.5, and 10.3% of patients received ampicillin-sulbactam alone, clindamycin alone, or an alternative regimen. Forty-six percent of patients had postoperative infections, and 22% had an infection at the flap inset site or neck incision. Increased risk of postoperative infection was seen with clindamycin use (odds ratio, 2.54; 95% confidence interval, 1.25–5.14), but not with extended duration of antibiotics (odds ratio, 0.63; 95% confidence interval, 0.34–1.19). In multivariate analysis, clindamycin and oral tobacco use, but not an extended course of antibiotics, correlated with increased risk of postoperative flap or neck infections.

“The choice of antibiotic appears to affect the rate of all postoperative infections and flap site infections more than the duration of antibiotics following head and neck free flap reconstruction,” the authors write.

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