Antibiotic Resistance and Surgical Site Infections in Free Flap Reconstruction for Head and Neck Cancer: A Retrospective Analysis From a Lower-Middle-Income Country.

[OBJECTIVE] This study aimed to analyze the frequency of infection and its causative organisms, with their antibiotic susceptibility pattern, in patients who underwent free flap reconstructive surgery for head and neck cancers.

[METHODOLOGY] This hospital record-based cross-sectional study was conducted at Aga Khan University Hospital in Karachi, Pakistan, involving 92 patients who underwent free flap reconstruction between January 1, 2023, and December 31, 2023. Data, including demographic information, surgical specifics, and microbial profiles, were collected from patient records, with a focus on postoperative wound infections after obtaining approval. Data analysis was done using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States).

[RESULTS] Among 92 patients, 11 (11.9%) developed surgical site infections (SSIs). Male gender and age between 41 and 60 years were significantly associated with the occurrence of SSIs (p < 0.001). There was no significant relationship between age, American Society of Anesthesiologists (ASA) score, comorbidities, and flap types. Gram-negative bacteria, particularly , dominated isolates. Early-onset SSIs were primarily associated with , whereas late-onset infections showed a broader spectrum of Gram-negative pathogens, including and species, suggesting temporal variations in microbial colonization. Multidrug-resistant organisms (MDROs) were identified in 66.6% of Gram-negative and all Gram-positive isolates, with extended drug resistance (XDRO) observed in select Gram-negative cases. was the most common Gram-negative isolate, while predominated among Gram-positive bacteria.

[CONCLUSION] SSI was noted in 11.9% of the free flap population. Tailored antibiotic prophylaxis is crucial due to significant antimicrobial resistance in Gram-negative bacteria like and . Vigilant postoperative monitoring is essential given consistent pathogenic profiles in early- and late-onset infections, urging careful antibiotic stewardship in managing these infections effectively.