Efficacy of topical antimicrobial prophylaxis for mucosal head and neck surgery: A meta-analysis

Introduction: We aim to understand the differences in surgical site infection (SSI) rates after major mucosal head and neck surgery between patients who received topical antimicrobial prophylaxis and those who did not. We recognize which topical antimicrobial treatments are available for mucosal application. We explain methods for designing a multicenter, prospective trial to determine whether topical antimicrobial prophylaxis should become standard of care for patients undergoing mucosal head and neck surgery. We believe this abstract deserves consideration for late-breaking status due to its novelty and interest to the larger otolaryngology community. Our institution has been recently interested in topical antimicrobials to reduce the spread of COVID-19 in health care settings. While we were studying the effects of topical antimicrobial prophylaxis applied intranasally on SARS-CoV-2 transmission in health care workers over the past several months, we decided to translate that work to assessing SSI rates after mucosal head and neck surgery. Before considering funding a multicenter prospective study on this topic, we proceeded with this systematic review and meta-analysis to help inform future trials. Our meta-analysis reveals a greater than 50% risk reduction in SSIs in patients who underwent perioperative topical antimicrobial therapy to the oral cavity and/or pharynx compared with patients who did not receive topical prophylaxis, which is both statistically significant and clinically meaningful. We believe these findings are pertinent to all otolaryngologists who perform mucosal surgery. Methods: A search of Ovid MEDLINE, Embase, Scopus, Cochrane Library, and Clinicaltrials.gov from inception to May 20, 2021, was performed. Clinical trials, cohort studies, and case-control studies with SSI rates of adults who underwent mucosal head and neck surgery and received perioperative topical antimicrobial therapy to the oral cavity and/or pharynx were included. Studies of dental procedures were excluded. Results: Of 265 unique citations, 9 studies were included. Topical treatments included clindamycin, tetracycline, piperacillintazobactam, ampicillin-carbenicillin, neomycin-erythromycin, mupirocin, and povidone-iodine. Pooled SSI rates of 252 patients with topical antimicrobial prophylaxis and 218 control patients without topical therapy were 8% (95% CI, 3%- 14%, I2 = 61.2%) and 29% (95% CI, 16%-43%, I2 = 79.5%), respectively. Another meta-analysis of 7 comparative studies totaling 192 topical therapy patients and 218 control patients revealed a pooled relative risk of 0.44 (95% CI, 0.28-0.68, I2 = 0.0%) in favor of the treatment group. Conclusion: Patients who underwent prophylactic topical antimicrobial therapy had less than half the risk of developing SSI after mucosal head and neck surgery compared with those who received no topical prophylaxis.