Intranasal Septal Splints: Prophylactic Antibiotics and Nasal Microbiology

Abstract

Objectives: Intranasal septal splints are often used in nasal septal surgeries. Routine use of postoperative antibiotics is an accepted practice, although data regarding its efficacy in preventing postsurgical complications are limited. This study aimed to examine bacterial colonization on septal splints following prophylactic antibiotic therapy and the association with postoperative infections. Methods: Fifty-five patients underwent septoplasty by a single surgeon between March 2015 and April 2016. All had intranasal septal splints and were given antibiotic prophylaxis for 7 days until removal of splints. Nasal cultures were taken before surgery, and septal splints were examined for bacterial colonization following their removal. Results: Thirty-six patients (65%) had positive nasal culture prior to surgery. The most common isolates were Staphylococcus aureus (30%) and Enterobacteriaceae species (66%). All these patients had postoperative bacterial colonization on septal splints. In 15 patients with negative preoperative cultures, bacteria were isolated postoperatively. An increased resistance profile was documented postoperatively in 9 patients (16%), including two with multidrug resistance. In two of these patients preoperative wild-type strains acquired antibiotic resistance postoperatively. No adverse drug reactions to antibiotics were reported. Conclusions: Increased bacterial growth and emergence of resistant strains were observed on intranasal septal splints despite prophylactic antibiotic treatment. Nonetheless, this did not translate into clinical infection. Thus, considering antibiotics overuse and increasing bacterial resistance, further research is needed to determine the role of antibiotic prophylaxis in the setting of intranasal splints.

Prolonged viral shedding identified from external splints and intranasal packings in immediately cured COVID-19 patients with nasal fractures: A retrospective study

“…Several investigators paid attention to bacterial profiles in relation to IP/intranasal splints (IP/IS) [5] , [6] , [7] , while we looked at SARS-CoV-2 shedding post-symptom in INBF patients. 40-87% of IP/IS are found to be contaminated, for example, with Staphylococcus aureus , and Enterobacteriaceae sp., and linked to serious complications, such as toxic shock syndrome, endocarditis, meningitis, and cavernous sinus thrombosis [5] , [6] , [7] .…”

“…Several investigators paid attention to bacterial profiles in relation to IP/intranasal splints (IP/IS) [5] , [6] , [7] , while we looked at SARS-CoV-2 shedding post-symptom in INBF patients. 40-87% of IP/IS are found to be contaminated, for example, with Staphylococcus aureus , and Enterobacteriaceae sp., and linked to serious complications, such as toxic shock syndrome, endocarditis, meningitis, and cavernous sinus thrombosis [5] , [6] , [7] . We prescribed a course of antibiotics for our patients because of delayed treatment with re-fracturing, subsequent mucosal breakdown, and nasal packing for 24-72 hours, in agreement with other authors [5] , [6] , [7] .…”

“…40-87% of IP/IS are found to be contaminated, for example, with Staphylococcus aureus , and Enterobacteriaceae sp., and linked to serious complications, such as toxic shock syndrome, endocarditis, meningitis, and cavernous sinus thrombosis [5] , [6] , [7] . We prescribed a course of antibiotics for our patients because of delayed treatment with re-fracturing, subsequent mucosal breakdown, and nasal packing for 24-72 hours, in agreement with other authors [5] , [6] , [7] . However, routine systemic antibiotic prophylaxis is “not” recommended (because of adverse drug reactions, e.g.…”

“…However, routine systemic antibiotic prophylaxis is “not” recommended (because of adverse drug reactions, e.g. emergence of resistant bacterial strains, anaphylaxis, or gastrointestinal disturbances), cost-effective, and evidence-based [5] , [6] , [7] , [8] . Merocel® porosity could increase biofilm formation [ 6 , 7 ], and antibiotic impregnation does not reduce microbial growth [5] .…”

Septoplasty with and without additional sinonasal surgery: postoperative sequelae and the use of prophylactic antibiotics

“…The majority of the analysed study populations in the review by Georgiou et al were rather small, varying from groups of 35 to 174 patients. This is often the case in studies examining the effects of prophylactic antibiotics in septoplasty [14][15][16]18], which automatically makes it difficult to reach proper statistical significance to prove their effect. Two of the studies analysed by Georgiou et al had considerably larger study populations (1040 and 2000 rhinoplasty patients) and both reported only few postoperative infections (0.48% and 0.6%, respectively), whereas our study presented noticeably higher rates, as high as 5.3%.…”