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.
Perrotti JA, Castor SA, Perez PC, Zins JE. Antibiotic use in aesthetic surgery: a national survey and literature review. Plast Reconstr Surg. 2002;109:1685-93.
Rajan GP, Fergie N, Fischer U, Romer M, Radivojevic V, Hee GK. Antibiotic prophylaxis in septorhinoplasty? A prospective, randomized study. Plast Reconstr Surg. 2005;116:1995-8.
Rechtweg JS, Paolini RV, Belmont MJ, Wax MK. Postoperative antibiotic use of septoplasty: a survey of practice habits of the membership of the American Rhinologic Society. Am J Rhinol. 2001;15:315-20.
Schwab JA, Pirsig W. Complications of septal surgery. Facial Plast Surg. 1997;13:3-14.
Angelos PC, Wang TD. Methicillin‐resistant Staphylococcus aureusinfection in septorhinoplasty. Laryngoscope. 2010;120:1309-11.
Barry AL, Jones RN. Bacterial antibiotic resistance before and after clinical application in the United States. Bull NY Acad Med. 1987;63:217.
Leonard D, Thompson D. Unusual septoplasty complication: Streptococcus viridansendocarditis. Ear Nose Throat J. 1998;77:827, 830-1.
Weimert TA, Yoder MG. Antibiotics and nasal surgery. Laryngoscope. 1980;90:667-72.
Yoder M, Weimert T. Antibiotics and topical surgical preparation solution in septal surgery. Otolaryngol Head Neck Surg. 1992;106:243-4.
Slavin SA, Rees TD, Guy CL, Goldwyn RM. An investigation of bacteremia during rhinoplasty. Plast Reconstr Surg. 1983;71:196-8.
Noble W, Williams R, Jevons MP, Shooter R. Some aspects of nasal carriage of staphylococci. J Clin Pathol. 1964;17:79-83.
Kluytmans J, Van Belkum A, Verbrugh H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev. 1997;10:505-20.
Mahon CR. Lehman DC. Manuselis GJ.Textbook of Diagnostic Microbiology - 5th ed. London: Elsevier Health Sciences 2014.
Armin S, Fallah F, Navidinia M, Vosoghian S. Prevalence of blaOXA-1 and blaDHA-1 AmpC β-Lactamase-Producing and Methicillin-Resistant Staphylococcus aureus in Iran, Arch Pediatr Infect Dis. 2017 ;5(4):e36778.
CLSI. Performance standards for antimicrobial susceptibility testing; twenty-second informational supplements M100-S22. 32. USA: CLSI; 2013;31:70–88.
Mäkitie A. Postoperative infection following nasal septoplasty. Acta OtoLaryngol. 2000;120:165-6.
Silk KL, Ali MB, Cohen BJ, Summersgill JT, Raff MJ. Absence of bacteremia during nasal septoplasty. Arch OtolaryngolHead Neck Surg. 1991;117:54-5.
Caniello M, Passerotti GH, Goto EY, Voegels RL, Butugan O. Antibiotics in septoplasty: is it necessary? Braz J Otorrinolaringol. 2005;71:734-8.
Lawson W, Kessler S, Biller HF. Unusual and fatal complications of rhinoplasty. ArchOtolaryngol. 1983;109:164-9.
Fairbanks D. Complications of nasal packing. Otolaryngol Head Neck surg. 1986;94:412-5.
Hull HF, Mann JM, Sands CJ, Gregg SH, Kaufman PW. Toxic shock syndrome related to nasal packing. Arch Otolaryngol. 1983;109:624-6.
Taasan V, Wynne JW, Cassisi N, Block AJ. The Effect of nasal packing on sleep‐disordered breathing and nocturnal oxygen desaturation. Laryngoscope. 1981;91:1163-72.
Philpott C, Sharma A, McKiernan D. Does methicillin-resistant Staphylococcus aureushave a significant role in the peri-operative course of patients undergoing rhinological surgery? J Laryngol Otol. 2009;123:191-4.
Elie‐Turenne MC, Fernandes H, Mediavilla JR, Rosenthal M, Mathema B, Singh A, et al. Prevalence and characteristics of Staphylococcus aureuscolonization among healthcare professionals in an urban teaching hospital. Infect Control Hosp Epidemiol. 2010;31:574-80.
Sharma A, Philpott C, Pope L, McKiernan D. Methicillin resistant Staphylococcus aureus: is it a problem for nasal surgery? J Laryngol Otol. 2007;121:415-8.
Kuehnert MJ, Kruszon-Moran D, Hill HA, McQuillan G, McAllister SK, Fosheim G, et al. Prevalence of Staphylococcus aureusnasal colonization in the United States, 2001–2002. J Infect Dis. 2006;193:172-9.
Lucet JC, Chevret S, Durand-Zaleski I, Chastang C, Regnier B. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureusat admission to the intensive care unit: results of a multicenter study. Arch Intern Med. 2003;163:181-8.
Lucet JC, Grenet K, Armand-Lefevre L, Harnal M, Bouvet E, Regnier B, et al. High prevalence of carriage of methicillin-resistant Staphylococcus aureusat hospital admission in elderly patients: implications for infection control strategies. Infect Control Hosp Epidemiol. 2005;26:121-6.
Kaygusuz I, Kizirgil A, Karlidag T, Yalçin S, Keles E, Yakupogullari Y, et al. Bacteriemia in septoplasty and septorhinoplasty surgery. Rhinology. 2003;41:76-9.
Ricci G, D'Ascanio L. Antibiotics in septoplasty: evidence or habit?Am J Rhinol Allergy. 2012;26(3):194-6.
Georgiou I,Mendes D.the role of antibiotics in rhinoplasty and septoplasty:a literature review.2009