Dynamic Shifts in the Oral Microbiota Following Cancer Surgery: A 172-Sample Longitudinal Study of Surgical Site Infection Risk

Background: Surgical site infection (SSI) is the leading cause of perioperative morbidity following oral cancer surgery, yet the role of the oral microbiota in SSI pathogenesis remains poorly defined. This study prospectively investigated microbiota dynamics in relation to SSI occurrence in patients undergoing resection for oral squamous cell carcinoma (OSCC). Methods: A total of 172 oral swab samples were collected from 45 OSCC patients across four longitudinal time points: baseline (~29 days pre-surgery), immediately pre-surgery (hospital admission), early post-surgery (within 5 days), and late post-surgery (6 to15 days). Bacterial composition was profiled by 16S-rDNA V3-V4 sequencing (172 successfully sequenced samples), and bacterial/human DNA ratios were quantified by qRT-PCR (170 samples evaluated). SSI was assessed within 30 days post-surgery using adapted CDC criteria. Results: Fourteen of 45 patients (31.1%) developed SSI. Younger age was significantly associated with SSI occurrence (median age 53.2 years in SSI group vs. 67.4 years in non-SSI group; p=0.011), with each one-year decrease in age conferring a 7% increased risk. Notably, younger patients presented with larger and more advanced tumors (T3/T4: median age 57.2 vs. 72.9 years for T1/T2; p=0.033), leading to more extensive surgical procedures. Across all 172 samples, surgery induced a marked post-operative reduction in bacterial load and diversity. However, at the late post-surgery time point (collection IV), patients with SSI exhibited significantly higher alpha-diversity compared to non-infected patients (p<0.05 for Observed, Shannon, and Simpson indices). Beta-diversity also differed significantly between groups at this time point (weighted UniFrac, p=0.043). Prevotella and Porphyromonas dominated SSI patients at infection, together accounting for ~40% of reads versus 9.5% in non-infected patients. Among the 172 samples analyzed longitudinally, Aggregatibacter abundance at the early post-surgery time point (collection III) emerged as a significant predictor of subsequent SSI (OR per 1% increase: 1.10; p=0.012), with frequencies >0.044% conferring a 5.7-fold higher risk. Conclusions: Our longitudinal analysis demonstrate that while OSCC surgery profoundly disrupts the oral microbiota, non-SSI patients restore their preoperative profile within 12 days. In contrast, SSI is characterized by persistent dysbiosis dominated by Prevotella and Porphyromonas. Younger patients with advanced tumors are at particular risk. Early post-surgical Aggregatibacter abundance may serve as a novel risk indicator for SSI, potentially enabling timely preventive interventions in high-risk patients.