Swegal Warren, Deeb Robert, Greene Joshua, Peterson Ed, Perri Mary-Beth, Bardossy Ana C, Zervos Marcus, Jones Lamont R
Department of Otolaryngology Head and Neck Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
Department of Otolaryngology Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
Facial Plast Surg Aesthet Med. 2020 May 11. doi: 10.1089/fpsam.2020.0115.
The relationship between nasal flora and infection rates in patients undergoing nasal surgery is of interest. This relationship has been studied though changes that may take place due to surgery have never been elucidated. To assess colonization rates and changes in colonization patterns of methicillin-resistant or methicillin-sensitive (MRSA/MSSA) in nasal flora in patients undergoing nasal surgery and to determine whether colonization is a risk factor for postoperative infection. Patients undergoing nasal surgery including septoplasty, rhinoplasty, or nasal valve repair were recruited prospectively. Patients completed a survey preoperatively concerning risk factors of postoperative infection. Nasal swabs and cultures were done preoperatively and at 1 week postoperatively. Patients were assessed for surgical site infections postoperatively. Fifty-five patients completed both preoperative and postoperative nasal swabs. Preoperative to postoperative colonization rates increased for MRSA (2-5%) and MSSA (22-36%). Of the 55 patients, 11 had a change in nasal flora postoperatively, 9 of whom were colonized with a strain. However, MSSA/MRSA colonization either preoperatively or postoperatively was not associated with surgical site infections. Gender was the only variable found to be associated with postoperative infection ( = 0.007) with all four infections occurring in females. MSSA and MRSA do not appear to be major risk factors for surgical site infection in nasal surgery, whereas prior nasal surgery is a risk factor. This is the first report of a change in nasal colonization after nasal surgery. This could have implications for antibiotic prophylaxis in select nasal surgery cases.
鼻腔手术患者的鼻腔菌群与感染率之间的关系备受关注。尽管人们对这种关系进行了研究,但手术可能导致的变化却从未得到阐明。本研究旨在评估鼻腔手术患者鼻腔菌群中耐甲氧西林或对甲氧西林敏感的金黄色葡萄球菌(MRSA/MSSA)的定植率及定植模式变化,并确定定植是否为术后感染的危险因素。前瞻性招募接受鼻中隔成形术、鼻整形术或鼻瓣膜修复术等鼻腔手术的患者。患者在术前完成关于术后感染危险因素的调查。术前及术后1周采集鼻拭子并进行培养。对患者术后的手术部位感染情况进行评估。55例患者完成了术前及术后的鼻拭子采集。MRSA的术前至术后定植率从2%升至5%,MSSA从22%升至36%。在这55例患者中,11例术后鼻腔菌群发生变化,其中9例被一种菌株定植。然而,术前或术后的MSSA/MRSA定植与手术部位感染无关。性别是唯一与术后感染相关的变量(P = 0.007),所有4例感染均发生在女性患者中。MSSA和MRSA似乎不是鼻腔手术中手术部位感染的主要危险因素,而既往鼻腔手术是一个危险因素。这是关于鼻腔手术后鼻腔定植变化的首份报告。这可能对某些鼻腔手术病例的抗生素预防用药具有启示意义。