Advertisement

Are postoperative antibiotics required after orthognathic surgery?

      Abstract

      The aim of this study was to investigate and compare the frequency of surgical site infection (SSI) between orthognathic patients who received only intraoperative antibiotics and patients who received intraoperative antibiotics plus postoperative antibiotics. A retrospective study was performed of patients treated by a single surgeon over the years 2006–2012 and 2016–2019. The primary predictor variable was antibiotic exposure. The control group received no postoperative prophylactic antibiotics. The study group received postoperative antibiotics. Both groups received prophylactic intraoperative antibiotics and performed postoperative chlorhexidine rinses. The primary outcome was SSI frequency. Univariate, bivariate, and multiple logistic regression analyses were performed; statistical significance was set at P ≤ 0.05. The sample comprised 333 patients. Their mean age was 30.7 ± 11.8 years. The study group included 129 patients (38.7%); the control group included 204 patients (61.3%). The frequency of SSI was 17.1% in the study group and 26.5% in the control group (P = 0.048). In the multivariable logistic regression, only alcohol consumption was significantly associated with an increased risk of SSI (odds ratio 2.46, 95% confidence interval 1.36–4.44; P = 0.003). In patients undergoing orthognathic surgery, postoperative antibiotic exposure in addition to intraoperative prophylaxis approached but was not statistically significant for a decreased risk of SSI (P = 0.067).

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sengupta S.
        • Chattopadhyay M.K.
        • Grossart H.
        The multifaceted roles of antibiotics and antibiotic resistance in nature.
        Front Microbiol. 2013; 447
        • Friedman N.D.
        • Temkin E.
        • Carmeli Y.
        The negative impact of antibiotic resistance.
        Clin Microbiol Infect. 2015; 5: 416-422
      1. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2019. 〈https://www.cdc.gov/drugresistance/biggest-threats.html〉 [Accessibility verified August 17, 2020].

        • Mangram A.J.
        • Horan T.C.
        • Pearson M.L.
        • Silver L.C.
        • Jarvis W.R.
        Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee.
        Am J Infect Control. 1999; 27: 97-132
        • Davis C.M.
        • Gregoire C.E.
        • Steeves T.W.
        • Demsey A.
        Prevalence of surgical site infections following orthognathic surgery: a retrospective cohort analysis.
        J Oral Maxillofac Surg. 2016; 74: 1199-1206
        • Tan S.K.
        • Lo J.
        • Zwahlen R.A.
        Perioperative antibiotic prophylaxis in orthognathic surgery: a systematic review and meta-analysis of clinical trials.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112: 19-27
        • Danda A.K.
        • Ravi P.
        Effectiveness of postoperative antibiotics in orthognathic surgery: a meta-analysis.
        J Oral Maxillofac Surg. 2011; 69: 2650-2656
        • Kreutzer K.
        • Storck K.
        • Weitz J.
        Current evidence regarding prophylactic antibiotics in head and neck and maxillofacial surgery.
        Biomed Res Int. 2014; 2014879437
        • Naimi-Akbar A.
        • Hultin M.
        • Klinge A.
        • Klinge B.
        • Tranæus S.
        • Lund B.
        Antibiotic prophylaxis in orthognathic surgery: a complex systematic review.
        PLoS One. 2018; 13e0191161
        • Oomens M.A.
        • Verlinden C.R.
        • Goey Y.
        • Forouzanfar T.
        Prescribing antibiotic prophylaxis in orthognathic surgery: a systematic review.
        Int J Oral Maxillofac Surg. 2014; 43: 725-731
        • Gaal A.
        • Bailey B.
        • Patel Y.
        • Smiley N.
        • Dodson T.
        • Kim D.
        • Dillon J.
        Limiting antibiotics when managing mandible fractures may not increase infection risk.
        J Oral Maxillofac Surg. 2016; 74: 2008-2018
      2. Specifications Manual for National Hospital Inpatient Quality Measures SCIP-Inf-1–10. SCIP-Inf 1: Prophylactic antibiotic received within one hour prior to surgical incision. Surgical Care Improvement Project, The Joint Commission, USA. 〈https://manual.jointcommission.org/releases/archive/TJC2010B/rsrc/Manual/MIF0110/SCIPInf1_Algorithm.pdf〉 [Accessibility verified October 28, 2020].

      3. Centers of Disease Control and Prevention. Healthcare-associated infections. 〈https://www.cdc.gov/hai/ssi/faq_ssi.html〉 [Accessibility verified October 18, 2021].

        • Spies C.
        • Tønnesen H.
        • Andreasson S.
        • Helander A.
        • Conigrave K.
        Perioperative morbidity and mortality in chronic alcoholic patients.
        Alcohol Clin Exp Res. 2001; 25: 164S-170S
        • Tønnesen H.
        • Nielsen P.R.
        • Lauritzen J.B.
        • Møller A.M.
        Smoking and alcohol intervention before surgery: evidence for best practice.
        Br J Anaesth. 2009; 102: 297-306
        • Blatt S.
        • Al-Nawas B.
        A systematic review of latest evidence for antibiotic prophylaxis and therapy in oral and maxillofacial surgery.
        Infection. 2019; 47: 519-555
        • Milic T.
        • Raidoo P.
        • Gebauer D.
        Antibiotic prophylaxis in oral and maxillofacial surgery: a systematic review.
        Br J Oral Maxillofac Surg. 2021; 59: 633-642