From the Department of Plastic Surgery, Korea University Guro Hospital.
Plast Reconstr Surg. 2020 Jul;146(1):27e-34e. doi: 10.1097/PRS.0000000000006893.
Surgical-site infection following complicated septorhinoplasty may result in serious complications. Therefore, efforts to prevent surgical-site infections after complicated septorhinoplasty are important. The purpose of this study was to analyze the microbiological profile of preoperative nasal swab cultures and to evaluate the effect of antibiotic prophylaxis and topical antibiotic decolonization according to the antibiotic sensitivity results of surgical-site infections in complicated septorhinoplasty.
This 10-year cohort study included the data on 437 consecutive patients who underwent complicated septorhinoplasty. The patients were categorized into three cohorts based on the time of preoperative nasal swab culture collection. Patients in cohort 1 did not undergo nasal swab cultures and received empirical antibiotics. Patients in cohort 2 underwent only one preoperative nasal swab culture and received microorganism-sensitive antibiotics. Patients in cohort 3 underwent repeated nasal swab cultures. The antibiotics were changed when microorganisms resistant to the empirical antibiotics were isolated. Microbiological data and the rates of surgical-site infection and inflammation were compared among the three cohorts.
Methicillin-sensitive Staphylococcus aureus was the most commonly isolated microorganism. In cohort 1, two (5 percent) and two (5 percent) patients experienced surgical-site infections and inflammation, respectively. In cohort 2, two (3 percent) and three (4 percent) patients experienced surgical-site infections and inflammation, respectively. In cohort 3, one (0.3 percent) and one (0.3 percent) patient experienced surgical-site infection and inflammation, respectively.
The present study demonstrated that preoperative screening using repeated nasal swab cultures, followed by appropriate antibiotic prophylaxis and topical antibiotic decolonization, may reduce surgical-site infection in complicated septorhinoplasty.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
复杂性鼻整形术后的手术部位感染可能导致严重的并发症。因此，努力预防复杂性鼻整形术后的手术部位感染是很重要的。本研究的目的是分析术前鼻拭子培养的微生物谱，并根据复杂性鼻整形术后手术部位感染的抗生素敏感性结果，评估抗生素预防和局部抗生素去定植的效果。
这是一项为期 10 年的队列研究，纳入了 437 例连续接受复杂性鼻整形术的患者的数据。根据术前鼻拭子培养采集时间，将患者分为三组。第 1 组患者未进行鼻拭子培养，接受经验性抗生素治疗。第 2 组患者仅进行一次术前鼻拭子培养，并接受对微生物敏感的抗生素治疗。第 3 组患者进行重复鼻拭子培养。当分离出对抗生素经验治疗耐药的微生物时，更换抗生素。比较三组的微生物数据以及手术部位感染和炎症的发生率。
甲氧西林敏感金黄色葡萄球菌是最常分离到的微生物。第 1 组患者中有 2 例（5%）和 2 例（5%）分别发生手术部位感染和炎症。第 2 组患者中有 2 例（3%）和 3 例（4%）分别发生手术部位感染和炎症。第 3 组患者中有 1 例（0.3%）和 1 例（0.3%）分别发生手术部位感染和炎症。
本研究表明，通过重复鼻拭子培养进行术前筛查，然后进行适当的抗生素预防和局部抗生素去定植，可能会降低复杂性鼻整形术后的手术部位感染率。
临床问题/证据水平：治疗性，III 级。
