Chitogel following endoscopic sinus surgery promotes a healthy microbiome and reduces postoperative infections

Abstract

Background: Postoperative infections following endoscopic sinus surgery (ESS) impair wound healing and lead to poor outcomes. The aim of this study is to assess the effectiveness of Chitogel to reduce postoperative infections and restore a healthy microbiome following ESS. Methods: In this double-blinded randomized control trial, 25 patients undergoing ESS were prospectively recruited. At the end of surgery, patients were randomized to receive Chitogel to one side of the sinuses (allowing the other side to serve as control). Patients underwent routine follow-up with nasoendoscopies performed at 2, 6, and 12 weeks postoperatively. Sinus ostial measurements, microbiology, and microbiome swabs from bilateral sides were collected intraoperatively and at 12 weeks postoperatively. Additional swabs were collected if infection was present.Results: Improved endoscopic appearance of the sinuses (p = 0.03) and ostial patency were noted on the Chitogel side compared with control at 12 weeks (p < 0.001). A significant decrease in infections on the Chitogel side (12.0%) compared with control (52.0%) (p = 0.005) was evident. Following the use of Chitogel, there was a significant increase in the combined relative abundance of commensals Corynebacterium and Cutibacterium (Propionibacterium) from 30.15% at baseline to 46.62% at 12 weeks compared with control (47.18% to 40.79%) (p.adj = 0.01). Conclusion:Chitogel significantly improved both the nasoendoscopic appearance of the sinuses and sinus ostial patency at 12 weeks postoperatively. Chitogel used following ESS helps restore an improved microbiome resulting in an increase in the relative abundance of commensals Corynebacterium and Cutibacterium (Propionibacterium). A significant decrease in postoperative infections was noted following use of Chitogel.

Effect of chitosan‐based gel dressing on wound infection, synechia, and granulations after endoscopic sinus surgery of nasal polyps: A meta‐analysis

“…A total of 6 studies reported between 2010 and 2022 satisfied the inclusion criteria for the meta‐analysis among the 546 distinctive reports. 10 , 11 , 12 , 13 , 14 , 15 This meta‐analysis study included 386 subjects after endoscopic sinus surgery of nasal polyps at the beginning of the study; 187 were using chitosan‐based gel dressing, and 199 were control. All studies evaluated the effect of chitosan‐based gel dressing on wound infection, synechia, and granulations after endoscopic sinus surgery of nasal polyps.…”

“…A total of 6 studies reported between 2010 and 2022 satisfied the inclusion criteria for the meta‐analysis among the 546 distinctive reports 10‐15 . This meta‐analysis study included 386 subjects after endoscopic sinus surgery of nasal polyps at the beginning of the study; 187 were using chitosan‐based gel dressing, and 199 were control.…”

“…This meta-analysis comprised 386 subjects after endoscopic sinus surgery of nasal polyps at the beginning of the study; 187 were using chitosan-based gel dressing, and 199 were control. [10][11][12][13][14][15] Chitosan-based gel dressing had significantly lower wound infection, and synechia compared with control in subjects with endoscopic sinus surgery of nasal polyps. However, no significant difference was found in granulations between chitosan-based gel dressing and control in subjects with endoscopic sinus surgery of nasal polyps.…”

“…This meta‐analysis comprised 386 subjects after endoscopic sinus surgery of nasal polyps at the beginning of the study; 187 were using chitosan‐based gel dressing, and 199 were control 10‐15 . Chitosan‐based gel dressing had significantly lower wound infection, and synechia compared with control in subjects with endoscopic sinus surgery of nasal polyps.…”

“… 9 Nasal dressing that consists of cross‐linking chitosan and dextran derivatives gel was used as a haemostatic agent postnasal surgery. 10 , 11 , 12 , 13 , 14 , 15 Earlier studies showed that chitosan‐based gel dressing was related to reduced synechia and crusting, and better wound healing post‐endoscopic sinus surgery. 10 However, some relevant randomised controlled trials showed that chitosan gel dressing has no influence on synechia, granulations, crusting, and wound infection.…”