Surgical Site Infection and Antimicrobial Resistance Following Resection and Reconstructive Surgery for Oral Cancers: Are We Ready for the Superbugs

ABSTRACT

Background: Surgical site infection (SSI) is the most common complication occurring in 19–47% of patients undergoing surgery for head-and-neck cancers. This study aims to assess the predictive factors of SSIs and antibiotic resistance patterns in patients undergoing resection and reconstructive surgery for oral cancers. Materials and Methods: The clinicopathological data of all patients who underwent surgery for oral cancers at our oncological referral center in South India between October 2014 and May 2019 were reviewed. The differences between groups were compared using independent samples t-test or Mann–Whitney U-test and categorical data were analyzed by Pearson’s Chisquare test, Fisher’s exact, or continuity correction where appropriate. Receiver operating characteristic (ROC) curve analysis was performed to find the cutoff levels for the various predictors of SSI, using the Youden’s index method. A linear regression analysis was done to define the cause-effect relationship of the categorical response variable with explanatory variables. Results: Of the 135 patients who were studied in our cohort, 43 patients (31.2%) developed SSI. The most commonly isolated organism was Staphylococcus aureus (11%; n = 15) followed by Enterococcus species (4.4%; n = 6) followed by coagulasenegative S. aureus (3%; n = 4) and Escherichia coli (37%; n = 5). In this study, univariate and multivariate analyses have showed that diabetes mellitus, body mass index (BMI) >25 or <18, neutrophil-to-lymphocyte ratio (NLR) >3.75, platelet-tolymphocyte ratio (PLR) >137.5, neoadjuvant chemotherapy or radiotherapy, prolonged operative duration, and prolonged anesthesia exposure may render patients more vulnerable to SSI. Moreover, among these parameters, a PLR >137.5, NLR >3.75, and BMI >25 or <18 were found to be highly predictive of SSI. The highly resistant organisms isolated were S. aureus and Enterococcus species in our study. Conclusion: The identification of these risk factors in patients undergoing surgery for oral cancers can help in the identification of patients who may be at a higher risk of developing SSI and therefore help in improving the overall outcome, especially in an LMIC setting.