Purpose The purpose of this study is to determine the effect of a 3- vs. 1-day antibiotic regimen on the rate of surgical site infection (SSI) in patients undergoing orthognathic surgery at the ...Department of Oral and Maxillofacial Surgery in Halifax, Nova Scotia, Canada. Patients and Methods A prospective, randomized controlled trial (RCT) was conducted. All patients received 1 day of intravenous (IV) antibiotics following surgery. The patients were then randomly distributed into groups that received 2 days of additional antibiotics (Group A) or placebo (Group B). The primary outcome measured was the presence of SSI. The operating surgeon; concomitant extraction of teeth; surgical procedures performed; duration of intermaxillary fixation (IMF) and length of hospital stay were analyzed for an effect on SSI. Patients were followed for 1 year following surgery to identify SSIs that may have been diagnosed outside of our hospital. Results The trial started with 288 patients, and 117 patients were lost to follow-up. Statistical analyses were ultimately performed on those 171 patients who were adherent to the study medication regimen. Group A (n=86) and B (n=85) SSI rates were 7.0 and 17.6% (p=0.04; NNT=10), respectively. The mandible/bilateral sagittal split osteotomy (BSSO) was involved in 71% of SSIs. Intra- and post-operative surgical variables did not have a significant effect on the SSI rate. Patients were followed for 1 year following surgery, where Group A (n=46) and Group B (n=44) had an SSI rate of 4 and 25% (p<0.05), respectively. Conclusions Three days of post-operative cefazolin/cephalexin significantly reduces SSI rates compared with 1 day. However, the NNT of 10 suggests that the benefits of the extended regimen may not outweigh the risks. The high prevalence of SSIs at the mandibular/BSSO incisions may be caused by contamination with more saliva and reception of a lower blood supply than maxillary/Le Fort I incisions. Mandibular osteotomies may benefit from an extended antibiotic regimen to minimize SSI and associated complications. Other surgical variables may not require special consideration for antibiotic therapy.
Summary
The polled locus has been mapped by genetic linkage analysis to the proximal region of bovine chromosome 1. As an intermediate step in our efforts to identify the polled locus and the ...underlying causative mutation for the polled phenotype, we have constructed a BAC‐based physical map of the interval containing the polled locus. Clones containing genes and markers in the critical interval were isolated from the TAMBT (constructed from Angus and Longhorn genomic DNA) and CHORI‐240 (constructed from horned Hereford genomic DNA) BAC libraries and ordered based on fingerprinting and the presence or absence of 80 STS markers. A single contig spanning 2.5 Mb was assembled. Comparison of the physical order of STSs to the corresponding region of human chromosome 21 revealed the same order of genes within the polled critical interval. This contig of overlapping BAC clones from horned and polled breeds is a useful resource for SNP discovery and characterization of positional candidate genes.
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