Antibiotic use in nasal bone fracture: a single-center retrospective study

Abstract

Background: Prophylactic antibiotics are used to prevent surgical wound infection; however, proper indications must be followed with careful consideration of the risks and benefits, especially in clean or clean-contaminated wounds. Nasal bone fractures are the most common type of facial bone fracture. The most common method for treating nasal bone fracture is closed reduction, which is performed inside the nasal cavity without an incision. The purpose of this study was to determine the need for antibiotic use in the closed reduction of nasal bone fractures.Methods: A retrospective study was conducted using data from the National Insurance Service Ilsan Hospital of the Republic of Korea between 2016 and 2018. The records of patients who underwent closed reduction of nasal bone fracture were reviewed and classified according to sex, age, comorbidities, perioperative antibiotic usage, postoperative complications, nasal packing, anesthesia type, surgeon’s specialty, and operation time.Results: Among the 373 patients studied, the antibiotic prescription rate was 67.3%. Just 0.8% of patients were prescribed preoperative antibiotics only, 44.0% were prescribed postoperative antibiotics only, and 22.5% were prescribed both preoperative and postoperative antibiotics. There were no cases that satisfied the definition of “surgical site infection.” Furthermore, 2.1% of infection-related complications (e.g., mucosal swelling, synechia, and anosmia) occurred only in the antibiotic usage group. The use of nasal packing, anesthesia type, and surgeon’s specialty did not show any difference in infection-related complication rates.Conclusion: According to the study findings, the routine use of perioperative antibiotics is not recommended in uncomplicated nasal bone fracture surgery.

The Role of Antibiotics in Nasal Fractures after Closed Reduction

“…While not specific sequelae of nasal fracture, prior studies have used similar metrics as surrogates for possible infection. 4 Consistent with prior studies, antibiotic prescription did not significantly decrease the rates of any symptoms recorded. This further indicates the good outcomes patients have following nasal fracture without antibiotic therapy.…”

“…Antibiotic prophylaxis in nasal fractures is commonplace, with our study and others suggesting prescription rates of over 50%. 4 Minimal research has assessed the utility of prophylactic antibiotics in the setting of open and closed nasal fractures in patients managed with closed reduction. We studied the impact of antibiotics on the development of infection for isolated nasal fractures managed by closed reduction, with the goal of providing specific guidelines for antibiotic stewardship.…”

“… 1 – 3 Sequelae of nasal fractures include structural changes to the osseous framework, septal deformity, and potential airway compromise. 4 Infection is less common, documented at a rate of approximately 2%. 4 …”

“…4 Infection is less common, documented at a rate of approximately 2%. 4 Treatment of nasal bone fractures involves repositioning of the nasal bones or bony fragments through open or closed reduction. Closed reduction is often preferred due to greater efficiency, avoidance of general anesthesia, and decreased invasiveness.…”

Cutaneous Verrucous Carcinomas: A Review

“…Besides, CVC can occur secondary to a variety of chronic skin conditions such as lupus vulgaris, lichen planus, sclerosing lichen planus, lichen simplex chronicus, lupus erythematosus, erythema elevatum diutinum, actinic keratosis, scars, ulcers, hidradenitis suppurativa, and pilonidal sinus. 15,23 -34 These also further suggest the role of chronic inflammation may be involved in the pathogenesis.…”