Perioperative Piperacillin/Tazobactam Reduces Early Onset SSI in Preirradiated Patients Undergoing Microvascular Head and Neck Reconstruction

Background Preirradiated patients undergoing microvascular head and neck reconstruction for tumor recurrence or osteoradionecrosis (ORN) face surgical site infection (SSI) rates exceeding 30%. The impact of perioperative extended-spectrum antibiotic coverage remains unclear. This study hypothesizes that calculated prophylaxis with piperacillin/tazobactam reduces early-onset SSI in this high-risk population. Methods From a microvascular reconstructed cohort, 161 with prior irradiation were retrospectively identified (tumor, N = 101; ORN, N = 60). SSI risk reduction was compared between patients receiving piperacillin/tazobactam (N = 39) and standard prophylaxis (N = 122). Results With underlying SSI incidence of 36%, piperacillin/tazobactam showed a fourfold SSI risk reduction (HR 0.24; p = 0.002) across the entire cohort and a fivefold reduction in patients with bone resection (HR 0.17; p = 0.01). Subgroup analyses confirmed this effect with a sevenfold reduction in tumor patients (HR 0.14; p = 0.008) and a threefold reduction in ORN patients (HR 0.29; p = 0.04). Extended coverage did not significantly prolong antibiotic treatment times. Conclusion In summary, calculated use of piperacillin/tazobactam in previously irradiated patients requiring microvascular reconstruction appears effective in reducing early-onset SSI.