Does methicillin-resistant<i>Staphylococcus aureus</i>have a significant role in the peri-operative course of patients undergoing rhinological surgery?

Philpott, Carl; Sharma, Akshat; McKiernan, David

doi:10.1017/s0022215108002855

Cited by 5 publications

(5 citation statements)

References 40 publications

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“…The major concern about prophylactic antibiotic consumption is the reduction or eradication of MSSA in anterior nares. Nonetheless, (1.5%) of the general population in the United States were recolonized with MRSA [23]. The displacement of MSSA, by the administration of the broad-spectrum antibiotics, facilitates the nasal colonization with MRSA [22].…”

Section: Discussionmentioning

confidence: 99%

“…Within this cohort, nurses demonstrated the highest MRSA prevalence of (10.4%) because of their frequent direct contact with patients. The prevalence of MRSA may be even higher among those, who work in intensive care environments [23]. Based on the medical literature, MRSA infections following septoplasty or septorhinoplasty are exceedingly rare; however, these types of infections may be under-diagnosed or under-reported.…”

Section: Discussionmentioning

confidence: 99%

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Role of Prophylactic Antibiotic Administration in Growth of Methicillin Resistant Staphylococcus Aureus in Rhinoplasty

Dilmaghani

Navidinia

Gachkar

et al. 2019

IJMTFM

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Background: Septoplasty and septorhinoplasty are common surgical procedures in modern surgical practice. Pre or postoperative antibiotic administration has raised concerns about the possible increase in the antibiotic-resistant species. The aim of this study was to evaluate the role of postoperative antibiotic prophylaxis in increasing Methicillin-Resistant Staphylococcus Aaureus species (MRSA) in patients, who underwent septoplasty or septorhinoplasty in Loghman Hakim Hospital in Tehran, Iran. Methods: A total of 102 patients, who were planned to undergo septoplasty or septorhinoplasty, participated in this double-blind randomized clinical trial. The patients were divided into the case (n=60, mean age of 28.2 years) and control (n=38, mean age of 28.9 years) groups. Overall, 98 patients participated in the study. The case group received a preoperative injection of cephalothin (1g) and postoperative oral cephalexin regimen (500mg 4 times a day for 7 days). The control group only received a preoperative injection of cephalothin (1g). Vestibular nasal swab cultures were obtained preoperatively and on postoperative day 7. The samples were, then, quickly transferred to the laboratory and cultured on proper media. The results indicated that five MRSA species in the case group and tow MRSA species in the control group were present, postoperatively. Results: The findings of this study suggest that oral antibiotic prophylaxis may lead to a statically non-significant increase in MRSA infection in patients, who require this treatment. Conclusion: Further knowledge of the endogenous nasal flora and the microbiology of common pathogens in patients undergoing septorhinoplasty will help reduce the incidence of infectious complications to a greater level.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of Prophylactic Antibiotic Administration in Growth of Methicillin Resistant Staphylococcus Aureus in Rhinoplasty

Dilmaghani

Navidinia

Gachkar

et al. 2019

IJMTFM

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“…1 Presence of MSSA is protective against colonization with MRSA. 2 Nonetheless, 1.5% of the general population in the United States is colonized with MRSA. 3 Displacement of MSSA through the use of broad-spectrum antibiotics facilitates nasal colonization with MRSA.…”

Section: Discussionmentioning

confidence: 99%

“…3 Displacement of MSSA through the use of broad-spectrum antibiotics facilitates nasal colonization with MRSA. 2 Indeed, MRSA nasal colonization is established in 4.2% of patients on admission and over 20% after an average-length hospitalization. 4 Health care workers are at increased risk of MRSA colonization.…”

Section: Discussionmentioning

confidence: 99%

“…The authors conclude that MRSA colonization is not a significant source of morbidity in nasal surgery patients. 2 In essence, there has been no demonstrated correlation between preoperative MRSA in endonasal surgery patients and subsequent infection. This issue continues to receive attention since S. aureus has been associated with an infection rate of 3% following nasal and sinus surgery.…”

Section: Discussionmentioning

confidence: 99%

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Methicillin-Resistant Staphylococcus aureus-Associated Infections following Septorhinoplasty

et al. 2012

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A 26-year-old healthy female nurse underwent an uncomplicated open approach septorhinoplasty for nasal obstruction and aesthetic concerns. The procedure consisted of a septoplasty, spreader grafts, cephalic trim, tongue-in-groove displacement of the lower-lateral cartilages, a dome-spanning suture, medial and lateral osteotomies, and bilateral type 2 Weir excisions. As per our standard practice, a single dose of preoperative azithromycin was provided given self-reported allergies to penicillin, cephalosporins, clindamycin, and sulfabased medications. Postoperatively, the patient was instructed to apply Bacitracin ointment to her incision sites for 3 days followed by petroleum jelly for 3 days. The patient convalesced well but contacted the on-call resident on the fourth postoperative day with concerns of persistent nasal discomfort despite narcotic analgesia. The patient was asked to return to the hospital for evaluation but elected to forgo assessment until her upcoming follow-up appointment. On postoperative day 6, the patient presented to the clinic with continuing discomfort and a fever of 38°C. Examination revealed inflammation and edema at the base of the caudal septum with some slight erythema at the nasal base. A diagnosis of cellulitis was considered and ciprofloxacin was prescribed. The patient returned to the clinic the following day for reassessment. The caudal septum appeared to be more fluctuant and the area was anesthetized, then incised and explored with a sterile hemostat, resulting in egress of a small amount of pus from a moderately sized pocket between the mucoperichondrial flaps. Aerobic and anaerobic cultures were taken from this early septal abscess. Sterile iodoform gauze was then loosely packed into the cavity and the patient returned the following day for reevaluation.Cultures revealed methicillin-resistant Staphylococcus aureus (MRSA) resistant to ciprofloxacin. The inflammation of the caudal septum appeared slightly improved and the iodoform gauze was removed. Review of the patient's allergy history revealed some uncertainty regarding a reaction to sulfa. Consequently, the patient was prescribed trimethoprim/sulfamethoxazole (TMP/SMX) and topical mupirocin AbstractSeptorhinoplasty is associated with postoperative infection in less than 2% of cases, even without the use of prophylactic antibiotics. However, there is a concern that increasingly prevalent, highly virulent pathogens such as MRSA may predispose to postoperative infections. Over the past several decades, MRSA has emerged as the most important cause of antibiotic-resistant nosocomial infection. MRSA-associated infections related to nasal surgery are underreported in the literature. We present a case of MRSA-associated infection following a routine septorhinoplasty in a health care worker. We discuss the incidence of this complication and contributing risk factors. The classification of MRSAassociated infections into genotypically distinct hospital-acquired and communityacquired subtypes is reviewed, and the associated differ...

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Post-operative MRSA infections in head and neck surgery

Lin

Melki

Lisgaris

et al. 2017

American Journal of Otolaryngology

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Does methicillin-resistantStaphylococcus aureushave a significant role in the peri-operative course of patients undergoing rhinological surgery?

Abstract: Methicillin-resistant Staphylococcus aureus infection does not represent a significant source of morbidity in our practice.

Cited by 5 publications

References 40 publications

Role of Prophylactic Antibiotic Administration in Growth of Methicillin Resistant Staphylococcus Aureus in Rhinoplasty

Role of Prophylactic Antibiotic Administration in Growth of Methicillin Resistant Staphylococcus Aureus in Rhinoplasty

Methicillin-Resistant Staphylococcus aureus-Associated Infections following Septorhinoplasty

Post-operative MRSA infections in head and neck surgery

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