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Mapping the risk factors, pathogens, and antibiotic of pharyngocutaneous fistula in patients after neck open surgery

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Abstract

Purpose

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.

Conclusion

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.

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Data availability

All data related to this study can be obtained by contacting the corresponding author.

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Funding

This study received no funding support.

Author information

Author notes

  1. Weili Kong and Manlin Chen have contributed to the work equally and should be regarded as the co-first authors.

Authors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Weili Kong, Manlin Chen, Hailing Gu & Hui Yang

  2. State Key Laboratory of Biological Therapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Yinze Han, Yuanzhi Liu & Xiaoyan Xia

Authors
  1. Weili Kong
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  2. Manlin Chen
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  6. Xiaoyan Xia
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  7. Hui Yang
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Contributions

Weili Kong and Manlin Chen were responsible for data analysis and manuscript writing. Hailing Gu obtained the raw data from the local hospital information center. Yinzhe Han and Yuanzhi Liu were responsible for data cleaning. Xiaoyan Xia conducted the statistical analysis of antibiotic sensitivity. Hui Yang designed the overall study and revised the manuscript.

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Correspondence to Hui Yang.

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The authors declare that there are no conflicts of interest regarding the publication of this paper.

Ethical approval

This study was approved by the local ethics committee of hospital with approval number 20221168.

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Kong, W., Chen, M., Gu, H. et al. Mapping the risk factors, pathogens, and antibiotic of pharyngocutaneous fistula in patients after neck open surgery. Eur Arch Otorhinolaryngol (2024). https://doi.org/10.1007/s00405-024-08642-9

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