Antibiotic Prophylaxis Prescribing Practice in Head and Neck Tumour Resection and Free Flap Reconstruction

Background Adherence to guidelines for antibiotic prophylaxis is often poor and is an important target for antimicrobial stewardship programs. Prescribing audits that suggested poor adherence to guidelines in a plastic surgery department led to a targeted education program to bring antibiotic prescriptions in line with hospital guidelines. We reviewed whether this intervention was associated with changed perioperative prescribing and altered surgical outcomes, including the rate of surgical site infections, specifically looking at clean-contaminated head and neck tumour resections with free flap reconstruction. Methods A retrospective cohort study was performed on 325 patients who underwent clean-contaminated head and neck tumour resection and free flap reconstruction from January 1, 2013 to February 19, 2019. Patients were divided into two groups, those before (pre-intervention) and after (post-intervention) the education campaign. We analysed patient demographic and disease characteristics, intraoperative and postoperative factors and surgical outcomes. Results Patients pre-intervention were prescribed longer courses of prophylactic antibiotics (median = 9 [interquartile range = 8] vs. median = 1 [interquartile range = 1], p < 0.001), more topical chloramphenicol ointment (21.82% vs. 0%, p < 0.001) and more oral nystatin (36.9% vs. 12.2%, p < 0.001). Patients post-intervention had higher rates of recipient infections (36.11% vs. 17.06%, p < 0.001) and donor site infections (6.94% vs. 1.19%, p = 0.006). Conclusion Following the education campaign, patients were prescribed shorter courses of prophylactic antibiotics, more of the recommended cefazolin-metronidazole regimen and less use of topical antibiotics. However, patients also had a higher rate of surgical site infections.