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Abstract
ABSTRACT
Background. Any surgical procedure involves an infectious risk due to the rupture of the barrier constituted by the skin or the mucous membranes. Through this study, we assessed the clinical, bacteriological and therapeutic profile of postoperative infections. Methods. This was a three year cross sectional retrospective study on a group of 138 patients with ENT cancer who had been extirpated. The circumstances of occurrence of post-operative infections were studied. Results. The frequency of post-operative infection was 23.9%. Among the 44 alcohol-smoking patients, 12 had a post-operative infection (p = 0.593). One patient had been treated with preoperative radiochemotherapy and dit not develop postoperative infection. The tumor size in the infected population corresponded to T2 (18.9%), T3 (22.5%), T4 (51.1%); p = 0.048 and the types of closure with flaps represented 17.9% (p = 0.001). Six class 1 Altemeier patients developed post-operative infection as well as 27 class 2; (p = 0.346). The incidence of infection in patients with a tracheostomy tube was 27.7%. The most common germs were Pseudomonas aeruginosa (16 cases), Enterobacter spp (4 cases), Staphylococcus aureus (3 cases). After consideration of the antibiogram, the most commonly used molecule was ciprofloxacin (21 cases). Conclusion. The occurrence of post-operative infection is strongly associated to the use of a closure flap, hence the need to observe strict hygiene for these patients who should benefit from it.
RÉSUMÉ
Introduction. Toute intervention chirurgicale comporte un risque infectieux du fait de la rupture de la barrière que constituent la peau ou les muqueuses. A travers cette étude, nous avons évalué le profil épidémiologique, bactériologique et thérapeutique des infections post opératoires. Patients et méthodes. Il s’agit d’une étude transversale rétrospective sur trois ans sur une série de 138 patients porteurs d’un cancer de la sphère ORL ayant été extirpé. Les circonstances de survenue des cas d’infections post opératoires ont été étudiées. Résultats. La fréquence de l’infection post opératoire était de 23,9%. Parmi les 44 patients alcoolo-tabagiques, 12 ont eu une infection post opératoire (p=0,593). Un patient ayant été traité par radio-chimiothérapie préopératoire n’a pas développé d’infection post opératoire. La taille de la tumeur dans la population infectée était celle correspondant aux classes T2 (18,9%), T3 (22,5%), T4 (51,1%); p=0,048 et les types de fermeture avec lambeaux représentaient 17,9 % (p=0,001). Six patients de classe 1 d’Altemeier ont développé une infection post opératoire ainsi que 27 de classe 2 ; (p=0,346). L’incidence de l’infection chez les malades porteurs d’une canule de trachéotomie était de 27,7%. Les germes les plus retrouvés avaient été le Pseudomonas aeruginosa (16 cas), Enterobacter spp (4 cas), Staphylococcus aureus (3 cas). Après l’adaptation à l’antibiogramme, la molécule la plus utilisée avait été la ciprofloxacine (21 cas). Conclusion. La survenue d’infection post opératoire a été fortement imputable à l’utilisation de lambeau de fermeture d’où la nécessité d’observer une hygiène stricte pour ces malades devant en bénéficier.
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References
- Garnier M, Blayau C, Fulgencio J P, et al. Conduite rationnelle de l’antibioprophylaxie : revue systématique en chirurgie carcinologique ORL. Annales Françaises d’Anesthésie et de Réanimation. 2013 ; 32 : 315–324
- Brun B. Les infections nosocomiales: bilan et perspectives. rev.med/sciences. 2000 ; 16 : 89-102
- Altemeier WB, Buke J, Pruitt B, Sandusky W. Manual of control of infection in surgical patients, 2nd ed, Philadelphia: Lippincott JB; 1984.
- Bourget A, Chang JT, Wu DB, Chang CJ, Wei FC. Free flap reconstruction in the head and neck region following radiotherapy: a cohort study identifying negative outcome predictors. Plast Reconstr Surg. 2011; 127: 1901–08.
- Suh JK, Sercarz JA, Abemayor E. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg. 2004; 130: 962–66.
- Liu SA, Tung KC, Shiao JY, Chiu YT. Preliminary report of associated factors in wound infection after major head and neck neoplasm operations–does the duration of prophylactic antibiotic matter. J Laryngol Otol. 2008; 122:403–8.
- Brown BM, Johnson JT, Wagner RL. Etiologic factors in head and neck wound infections. Laryngoscope 1987 ; 97:587–90.
- Lotfi CJ, Cavalcanti Rde C, Costa e Silva, et al. Risk factors for surgical-site infections in head and neck cancer surgery. Otolaryngol Head Neck Surg. 2008;138:74–80.
- Johnson JT, Myers EN, Thearle PB, et al. Antimicrobial prophylaxis for contaminated head and neck surgery. Laryngoscope. 1984;94:46–51.
- Weber RS, Raad I, Frankenthaler R, et al. Ampicillin-sulbactam vs clindamycin in head and neck oncologic surgery. The need for Gram-negative coverage. Arch Otolaryngol Head Neck Surg. 1992;118:1159–63
- Nielsen HJ, Reimert CM, Pedersen AN, et al. Time-dependent, spontaneous release of white cell- and platelet-derived bioactive substances from stored human blood. Transfusion. 1996;36:960–5.
- Frewin DB, Jonsson JR, Head RJ, et al. Histamine levels in stored human blood. Transfusion. 1984 ; 24:502–4.
- Fraioli R, Johnson JT. Prevention and treatment of postsurgical head and neck infections. Curr Infect Dis Rep. 2004; 6: 172-180
- Dassonville O, Poissonnet G, Chamorey E. Head and neck reconstruction with free flaps: a report on 213 cases. Eur Arch Otorhinolaryngol. 2008; 265: 85–95.
- Benatar MJ, Dassonville O, Chamorey E. Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases. J Plast Reconstr Aesthet Surg. 2013; 66: 478–82.
- Lee DH, Kim SY, Nam SY, Choi SH, et al. Risk factors of surgical site infection in patients undergoing major oncological surgery for head and neck cancer. Oral Oncology. 2011 ; 47 :528–531
- Cole RR, Robbins KT, Cohen JI, Wolf PF. A predictive model for wound sepsis in oncologic surgery of the head and neck. Otolaryngol Head Neck Surg. 1987;96(2):165–71.
- Ogihara H, Takeuchi K, Majima Y. Risk factors of postoperative infection in head and neck surgery. Auris Nasus Larynx. 2009; 36: 457-460
- Belusic-Gobic M. Multivariate analysis of risk factors for postoperative wound infection following oral and oropharyngeal cancer surgery. Journal of Cranio-Maxillo-Facial Surgery. 2018; 46(1) : 135-141.
- Karakida K, Aoki T, Ota Y. Analysis of risk factors for surgical-site infections in 276 oral cancer surgeries with microvascular free-flap reconstructions at a single university hospital. J Infect Chemother. 2010; 16: 334–39.
- Becker GD, Parell GJ. Cefazolin prophylaxis in head and neck cancer surgery. Ann Otol Rhinol Laryngol. 1979; 88: 183–86.
- H. Rodriguez-Villalobos, M.-J. Struelens. Résistance bactérienne par β-lactamases à spectre étendu : implications pour le réanimateur. Réanimation. 2006 ; 15(3) : 205-213.
- Sá Breda M. Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis. Acta Otorrinolaringologica (English Edition). 2019 ; 70(1) :6-15.
References
Garnier M, Blayau C, Fulgencio J P, et al. Conduite rationnelle de l’antibioprophylaxie : revue systématique en chirurgie carcinologique ORL. Annales Françaises d’Anesthésie et de Réanimation. 2013 ; 32 : 315–324
Brun B. Les infections nosocomiales: bilan et perspectives. rev.med/sciences. 2000 ; 16 : 89-102
Altemeier WB, Buke J, Pruitt B, Sandusky W. Manual of control of infection in surgical patients, 2nd ed, Philadelphia: Lippincott JB; 1984.
Bourget A, Chang JT, Wu DB, Chang CJ, Wei FC. Free flap reconstruction in the head and neck region following radiotherapy: a cohort study identifying negative outcome predictors. Plast Reconstr Surg. 2011; 127: 1901–08.
Suh JK, Sercarz JA, Abemayor E. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg. 2004; 130: 962–66.
Liu SA, Tung KC, Shiao JY, Chiu YT. Preliminary report of associated factors in wound infection after major head and neck neoplasm operations–does the duration of prophylactic antibiotic matter. J Laryngol Otol. 2008; 122:403–8.
Brown BM, Johnson JT, Wagner RL. Etiologic factors in head and neck wound infections. Laryngoscope 1987 ; 97:587–90.
Lotfi CJ, Cavalcanti Rde C, Costa e Silva, et al. Risk factors for surgical-site infections in head and neck cancer surgery. Otolaryngol Head Neck Surg. 2008;138:74–80.
Johnson JT, Myers EN, Thearle PB, et al. Antimicrobial prophylaxis for contaminated head and neck surgery. Laryngoscope. 1984;94:46–51.
Weber RS, Raad I, Frankenthaler R, et al. Ampicillin-sulbactam vs clindamycin in head and neck oncologic surgery. The need for Gram-negative coverage. Arch Otolaryngol Head Neck Surg. 1992;118:1159–63
Nielsen HJ, Reimert CM, Pedersen AN, et al. Time-dependent, spontaneous release of white cell- and platelet-derived bioactive substances from stored human blood. Transfusion. 1996;36:960–5.
Frewin DB, Jonsson JR, Head RJ, et al. Histamine levels in stored human blood. Transfusion. 1984 ; 24:502–4.
Fraioli R, Johnson JT. Prevention and treatment of postsurgical head and neck infections. Curr Infect Dis Rep. 2004; 6: 172-180
Dassonville O, Poissonnet G, Chamorey E. Head and neck reconstruction with free flaps: a report on 213 cases. Eur Arch Otorhinolaryngol. 2008; 265: 85–95.
Benatar MJ, Dassonville O, Chamorey E. Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases. J Plast Reconstr Aesthet Surg. 2013; 66: 478–82.
Lee DH, Kim SY, Nam SY, Choi SH, et al. Risk factors of surgical site infection in patients undergoing major oncological surgery for head and neck cancer. Oral Oncology. 2011 ; 47 :528–531
Cole RR, Robbins KT, Cohen JI, Wolf PF. A predictive model for wound sepsis in oncologic surgery of the head and neck. Otolaryngol Head Neck Surg. 1987;96(2):165–71.
Ogihara H, Takeuchi K, Majima Y. Risk factors of postoperative infection in head and neck surgery. Auris Nasus Larynx. 2009; 36: 457-460
Belusic-Gobic M. Multivariate analysis of risk factors for postoperative wound infection following oral and oropharyngeal cancer surgery. Journal of Cranio-Maxillo-Facial Surgery. 2018; 46(1) : 135-141.
Karakida K, Aoki T, Ota Y. Analysis of risk factors for surgical-site infections in 276 oral cancer surgeries with microvascular free-flap reconstructions at a single university hospital. J Infect Chemother. 2010; 16: 334–39.
Becker GD, Parell GJ. Cefazolin prophylaxis in head and neck cancer surgery. Ann Otol Rhinol Laryngol. 1979; 88: 183–86.
H. Rodriguez-Villalobos, M.-J. Struelens. Résistance bactérienne par β-lactamases à spectre étendu : implications pour le réanimateur. Réanimation. 2006 ; 15(3) : 205-213.
Sá Breda M. Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis. Acta Otorrinolaringologica (English Edition). 2019 ; 70(1) :6-15.