Karaman E, Alimoglu Y, Aygun G, Kilic E, Yagiz C
Otolaryngology Department, Cerrahpasa Medical Faculty, Istanbul University, Turkey.
B-ENT. 2012;8(1):13-9.
Septoplasty is one of the most commonly performed procedures in otolaryngology practice. Prophylactic use of antibiotics is controversial. Disruption of nasal flora may predispose individuals to infection. We investigated the effect of antibiotic prophylaxis and septoplasty on nasal flora.
We included 115 consecutive patients who underwent septoplasty because of symptomatic nasal septal deviation. Patients were divided into study and control groups. Study patients received prophylactic parenteral sodium cefazoline twice a day beginning intra-operatively and while the nasal packing remained in the nose for 48 h, and expandable polyvinyl acetate (Merocel) packing covered with antibiotic ointment containing 0.2% nitrofurazone was inserted into each nostril at the end of the operation. Control patients received neither parenteral antibiotic prophylaxis nor antibiotic ointment around the Merocel packs. Both groups received oral prophylactic cefuroxime axetil for 5 d after nasal packing was removed. Nasal flora was determined pre-operatively, post-operatively when nasal packing was removed, and 3 mo after surgery.
Study patients were compared to control patients at pack removal and 1 mo after surgery The effect of antibiotic use in septoplasty on nasal flora was as follows: Increased isolation rate of gram-positive rods (p = 0.007), decreased methicillin-sensitive coagulase-negative staphylococci (p = 0.002). Pre-operative and post-operative culture results at 3 mo were compared. The effect of septoplasty on nasal flora was as follows: Decreased coagulase-negative staphylococci (p = 0.05), decreased Klebsiella (p < 0.001), decreased gram-positive rods (p < 0.001), increased methicillin-sensitive Staphylococcus aureus (p < 0.001).
Septoplasty increases S. aureus colonization and decreases normal flora. Antibiotics do not protect against S. aureus colonization and contribute to a decrease in normal flora. Antibiotics do not seem to confer benefit in terms of flora changes. Studies investigating flora changes with a longer follow-up should be conducted.
鼻中隔成形术是耳鼻喉科最常开展的手术之一。预防性使用抗生素存在争议。鼻内菌群的破坏可能使个体易受感染。我们研究了抗生素预防及鼻中隔成形术对鼻内菌群的影响。
我们纳入了115例因症状性鼻中隔偏曲而接受鼻中隔成形术的连续患者。患者被分为研究组和对照组。研究组患者从手术中开始每天接受两次预防性静脉注射头孢唑林钠，持续48小时，直到鼻腔填塞物仍留在鼻腔内，并且在手术结束时将涂有含0.2%呋喃西林抗生素软膏的可膨胀聚醋酸乙烯酯（美罗培南）填塞物插入每个鼻孔。对照组患者既不接受静脉抗生素预防，美罗培南填塞物周围也不使用抗生素软膏。两组在取出鼻腔填塞物后均接受口服预防性头孢呋辛酯5天。在术前、取出鼻腔填塞物后及术后3个月测定鼻内菌群。
在取出填塞物时及术后1个月将研究组患者与对照组患者进行比较。鼻中隔成形术中使用抗生素对鼻内菌群的影响如下：革兰氏阳性杆菌的分离率增加（p = 0.007），对甲氧西林敏感的凝固酶阴性葡萄球菌减少（p = 0.002）。比较术前和术后3个月的培养结果。鼻中隔成形术对鼻内菌群的影响如下：凝固酶阴性葡萄球菌减少（p = 0.05），克雷伯菌减少（p < 0.001），革兰氏阳性杆菌减少（p < 0.001），对甲氧西林敏感的金黄色葡萄球菌增加（p < 0.001）。
鼻中隔成形术增加金黄色葡萄球菌定植并减少正常菌群。抗生素不能预防金黄色葡萄球菌定植，反而会导致正常菌群减少。就菌群变化而言，抗生素似乎没有益处。应开展随访时间更长的研究来调查菌群变化。
