Abstract：
OBJECTIVE: Current literature lacks consensus on risk factors for pharyngocutaneous fistula (PCF), and empirical antibiotic guidelines for PCF are limited. The aim of this study was to reduce the incidence of PCF and improve antibiotic treatment efficacy for patients with PCF after open neck surgery by analyzing their clinical characteristics, pathogenic bacteria, and antibiotic susceptibility.
METHODS: This study was a 13-year single-center retrospective cohort study, including 699 patients who underwent open neck surgery for laryngeal and hypopharyngeal cancer. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors associated with the occurrence of PCF after surgery. The microbial species causing PCF were analyzed, and the antibiotic sensitivity of the top three pathogens was assessed. Venn diagrams were used to illustrate the antibiotics that exhibited 100% sensitivity against all three identified pathogens.
RESULTS: The incidence of PCF after open neck surgery was 8%. Logistic univariate and multivariate analyses revealed that flap reconstruction (OR = 3.62, 95% CI [2.02-6.52]), history of preoperative radiotherapy (OR = 2.01, 95% CI [1.31-2.73]), significant postoperative bleeding (OR = 1.79, 95% CI [1.11-2.69]), and history of diabetes (OR = 1.34, 95% CI [1.29-2.46]) were significantly associated with PCF occurrence. Among the 38 cases of PCF patients, the top three identified pathogens were Pseudomonas aeruginosa, Escherichia coli, and Enterobacter cloacae. The antibiotics cefepime, meropenem, ticarcillin/clavulanic acid, and cefoperazone/sulbactam showed 100% sensitivity against these top three pathogens.
CONCLUSIONS: Special attention should be given to patients undergoing open neck surgery, especially those with intraoperative flap reconstruction, a history of preoperative radiotherapy, postoperative bleeding, or diabetes. Strengthening monitoring and care is crucial in preventing the occurrence of PCF. According to antibiotic usage guidelines and considering the distribution of pathogens in PCF patients, empirical antibiotic treatment with cefoperazone/sulbactam or ticarcillin/clavulanic acid is recommended prior to obtaining susceptibility test results.
METHODS: This study was a 13-year single-center retrospective cohort study, including 699 patients who underwent open neck surgery for laryngeal and hypopharyngeal cancer. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors associated with the occurrence of PCF after surgery. The microbial species causing PCF were analyzed, and the antibiotic sensitivity of the top three pathogens was assessed. Venn diagrams were used to illustrate the antibiotics that exhibited 100% sensitivity against all three identified pathogens.
RESULTS: The incidence of PCF after open neck surgery was 8%. Logistic univariate and multivariate analyses revealed that flap reconstruction (OR = 3.62, 95% CI [2.02-6.52]), history of preoperative radiotherapy (OR = 2.01, 95% CI [1.31-2.73]), significant postoperative bleeding (OR = 1.79, 95% CI [1.11-2.69]), and history of diabetes (OR = 1.34, 95% CI [1.29-2.46]) were significantly associated with PCF occurrence. Among the 38 cases of PCF patients, the top three identified pathogens were Pseudomonas aeruginosa, Escherichia coli, and Enterobacter cloacae. The antibiotics cefepime, meropenem, ticarcillin/clavulanic acid, and cefoperazone/sulbactam showed 100% sensitivity against these top three pathogens.
CONCLUSIONS: Special attention should be given to patients undergoing open neck surgery, especially those with intraoperative flap reconstruction, a history of preoperative radiotherapy, postoperative bleeding, or diabetes. Strengthening monitoring and care is crucial in preventing the occurrence of PCF. According to antibiotic usage guidelines and considering the distribution of pathogens in PCF patients, empirical antibiotic treatment with cefoperazone/sulbactam or ticarcillin/clavulanic acid is recommended prior to obtaining susceptibility test results.
摘要：
目的：目前文献对咽皮瘘（PCF）的危险因素缺乏共识，PCF的经验性抗生素指南有限。本研究旨在通过分析颈开放手术后PCF患者的临床特点，降低PCF的发生率，提高抗生素治疗效果。病原菌，和抗生素敏感性。
方法：本研究是一项为期13年的单中心回顾性队列研究，包括699例喉癌和下咽癌患者进行了颈部开放手术。采用单因素和多因素logistic回归分析确定术后PCF发生的危险因素。分析了导致PCF的微生物种类，并评估了前三名病原体的抗生素敏感性。使用维恩图来说明对所有三种鉴定的病原体表现出100%敏感性的抗生素。
结果：颈开放手术后PCF的发生率为8%。Logistic单因素和多因素分析显示皮瓣重建(OR=3.62,95%CI[2.02-6.52]),术前放疗史(OR=2.01,95%CI[1.31-2.73]),术后明显出血(OR=1.79,95%CI[1.11-2.69]),糖尿病病史(OR=1.34,95%CI[1.29-2.46])与PCF发生显著相关。在38例PCF患者中，鉴定前3位的病原菌是铜绿假单胞菌,大肠杆菌,阴沟肠杆菌.抗生素头孢吡肟，美罗培南,替卡西林/克拉维酸，头孢哌酮/舒巴坦对这三种病原体的敏感性为100％。
结论：应特别注意接受开放颈部手术的患者，尤其是那些术中皮瓣重建，术前放疗史,术后出血,或糖尿病。加强监测和护理对于预防PCF的发生至关重要。根据抗生素使用指南并考虑PCF患者的病原体分布，在获得药敏试验结果之前,建议使用头孢哌酮/舒巴坦或替卡西林/克拉维酸进行经验性抗生素治疗.
方法：本研究是一项为期13年的单中心回顾性队列研究，包括699例喉癌和下咽癌患者进行了颈部开放手术。采用单因素和多因素logistic回归分析确定术后PCF发生的危险因素。分析了导致PCF的微生物种类，并评估了前三名病原体的抗生素敏感性。使用维恩图来说明对所有三种鉴定的病原体表现出100%敏感性的抗生素。
结果：颈开放手术后PCF的发生率为8%。Logistic单因素和多因素分析显示皮瓣重建(OR=3.62,95%CI[2.02-6.52]),术前放疗史(OR=2.01,95%CI[1.31-2.73]),术后明显出血(OR=1.79,95%CI[1.11-2.69]),糖尿病病史(OR=1.34,95%CI[1.29-2.46])与PCF发生显著相关。在38例PCF患者中，鉴定前3位的病原菌是铜绿假单胞菌,大肠杆菌,阴沟肠杆菌.抗生素头孢吡肟，美罗培南,替卡西林/克拉维酸，头孢哌酮/舒巴坦对这三种病原体的敏感性为100％。
结论：应特别注意接受开放颈部手术的患者，尤其是那些术中皮瓣重建，术前放疗史,术后出血,或糖尿病。加强监测和护理对于预防PCF的发生至关重要。根据抗生素使用指南并考虑PCF患者的病原体分布，在获得药敏试验结果之前,建议使用头孢哌酮/舒巴坦或替卡西林/克拉维酸进行经验性抗生素治疗.
