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

Abstract

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.

Evidence-Based Medicine: Systemic Perioperative Antibiotic Prophylaxis for Prevention of Surgical-Site Infections in Plastic and Reconstructive Surgery

“…Five summary-of-findings tables and five clinical summary tables were created corresponding to clinical sections of Plastic and Reconstructive Surgery (Breast, Cosmetic, Hand/Peripheral Nerve, Pediatric/Craniofacial, and Reconstructive sections). Of the 138 included RCTs, 18 were breast (Tables 2 and 3), 10–27 10 cosmetic (Tables 4 and 5), 28–37 21 hand/peripheral nerve (Tables 6 and 7), 38–58 61 pediatric/craniofacial (Tables 8 and 9), 16,59–118 and 41 reconstructive (Tables 10 and 11). 16,28,38–42,54–56,119–149 Forest plots are provided for all comparisons.…”

“…• Infection occurring <30 or <90 days after the operation and the infection involves any part of the body, excluding the skin incision, fascia, or muscle layers, that is opened or manipulated during the operative procedure and the patient has at least one of the following: ▪ Purulent drainage from a drain that is placed into the organ/space ▪ Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space ▪ An abscess or other evidence of infection involving the organ/space that is found on direct examination, during an invasive procedure, or by histopathologic examination or imaging test ▪ Diagnosis of an organ/space SSI by a surgeon or attending physician ▪ Meets at least one criterion for a specific organ/space infection site (eg, bone, breast abscess or mastitis, ear, mastoid, oral cavity, sinusitis) 2 and 3), 10-27 10 cosmetic (Tables 4 and 5), [28][29][30][31][32][33][34][35][36][37] 21 hand/peripheral nerve (Tables 6 and 7), 61 pediatric/craniofacial (Tables 8 and 9), 16, and 41 reconstructive (Tables 10 and 11). Plastic and Reconstructive Surgery • December 2023 1158e [11][12][13] Evidence: No support for preoperative and/or postoperative systemic antibiotics.…”

“…29,33 Evidence: Supports preoperative systemic antibiotics. [29][30][31][32][33][34][35][36] Alternative: moxifloxacin 400 mg once preoperatively (no intraoperative redosing) followed by 400 mg daily (IV or oral-adult only).…”