Methicillin‐resistant <i>Staphylococcus aureus</i> infection in septorhinoplasty

Angelos, Patrick C.; Wang, Tom D.

doi:10.1002/lary.20966

Cited by 17 publications

(12 citation statements)

References 20 publications

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“…21,22 First-or secondgeneration cephalosporins are generally used for prophylaxis, whereas those patients at risk of colonization with methicillin-resistant Staphylococcus aureus require alternate preoperative and postoperative prophylaxis. [23][24][25] The use of antibiotics in nasal surgery, however, remains a point of controversy. Despite several studies citing no difference in infection rates with the use of postoperative prophylactic antibiotics, a 200% increase in the use of perioperative antibiotics in rhinoplasty has occurred from 1985 to 2000.…”

Section: Antibioticsmentioning

confidence: 99%

“…23,[26][27][28][29] This trend for postoperative antibiotic prophylaxis likely originates from the fear of toxic shock syndrome, the use of intranasal splints, the clean-contaminated nature of the surgical wound, the increased incidence of methicillin-resistant Staphylococcus aureus colonization, and the use of multiple grafts in revision procedures. 14,25 Corticosteroids The use of perioperative corticosteroids has long been debated, with conflicting data on the efficacy of routine systemic corticosteroid administration in rhinoplasty. The rationale behind prescribing perioperative corticosteroids stems from protracted cases of ecchymosis leading to discoloration of the skin or significant edema altering the ultimate result.…”

Section: Antibioticsmentioning

confidence: 99%

See 1 more Smart Citation

Practice Patterns in the Perioperative Treatment of Patients Undergoing Septorhinoplasty

Shadfar

Deal

Jarchow

et al. 2014

JAMA Facial Plast Surg

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Section: Antibioticsmentioning

confidence: 99%

Section: Antibioticsmentioning

confidence: 99%

Practice Patterns in the Perioperative Treatment of Patients Undergoing Septorhinoplasty

Shadfar

Deal

Jarchow

et al. 2014

JAMA Facial Plast Surg

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“…Few cases of MRSA infection following septorhinoplasty have been reported in the literature. Elimination Concurrent Rhinoplasty and Endoscopic Sinus Surgery DOI: http://dx.doi.org /10.5772/intechopen.89415 of nasal colonization is a major step in preventing these infections, and preoperative systemic antibiotic use should be considered, especially in revision cases [27].…”

Section: Discussionmentioning

confidence: 99%

Concurrent Rhinoplasty and Endoscopic Sinus Surgery

Gendeh¹

2019

Rhinosinusitis

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Combining rhinoplasty and endoscopic sinus surgery (ESS) was first reported in 1991 by Sheman and Matarasso. Since then, many authors have documented a large series showing the overall efficacy of combining the two procedures. The focus of this manuscript is to document the author's recent experience with combining rhinoplasty and endoscopic sinus surgery and highlight the changes that have occurred during the author's 2-years experience. A retrospective data review was performed on 53 (31 females and 22 men, age range 16-55 years) patients who underwent combined rhinoplasty and ESS between January 2016 and December 2018 at Pantai Hospital Kuala Lumpur by the same surgeon. The mean age was 31.8 years. All patients had severe nasal obstruction with chronic rhinosinusitis and were followed up for a minimum of 6 months post-surgery and underwent ENT workup, which included history, office rigid endoscopy, CT scans of paranasal sinuses and preoperative photography. Initially, the ESS was performed followed by the open rhinoplasty with or without osteotomy. The ESS consisted of middle turbinate reduction [15/53 (28.3%)], maxillary antrostomy [36/53 (67.9%)], ethmoidectomy [38/53 (71.6%)], frontal sinusotomy [7/53 (13.2%)], and sphenoidotomy [9/53 (16.9%)]. Most of the sinus symptoms resolved postoperatively with 47 (88.6%) of 53 patients describing their improvement as significant. Fifty (94.3%) of 53 patients stated that they would recommend the concurrent procedure. The benefits of these advances are illustrated by a review of the literature with good results (functional and cosmetic) and minimal complications.

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“…4 Despite the lack of evidence for MRSA-induced infection in nasal surgery, in the general surgery specialty literature, elimination of nasal S. aureus preoperatively results in a 50% reduction in surgical site infections. 13 This has prompted many practitioners to advocate the prophylactic eradication of nasal MRSA. Three strategies have demonstrated efficacy for preoperative eradication of MRSA: (1) local application of antibiotics or disinfectants, (2) treatment with systemic antibiotics, and (3) bacterial interference using a nonpathogenic Staphylococcus strain to competitively inhibit MRSA growth.…”

Section: Discussionmentioning

confidence: 99%

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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Methicillin‐resistant Staphylococcus aureus infection in septorhinoplasty

Cited by 17 publications

References 20 publications

Practice Patterns in the Perioperative Treatment of Patients Undergoing Septorhinoplasty

Practice Patterns in the Perioperative Treatment of Patients Undergoing Septorhinoplasty

Concurrent Rhinoplasty and Endoscopic Sinus Surgery

Methicillin-Resistant Staphylococcus aureus-Associated Infections following Septorhinoplasty

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