Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, United States of America.
Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Pennsylvania State University, United States of America.
Am J Otolaryngol. 2024 Jul-Aug;45(4):104333. doi: 10.1016/j.amjoto.2024.104333. Epub 2024 Apr 24.
Septoplasty and rhinoplasty are common otolaryngological procedures, often combined as septorhinoplasty (SRP), offering aesthetic and functional benefits. These surgeries are believed to potentially risk postoperative infections due to natural bacterial flora in the nares. This study evaluates the effectiveness of prophylactic antibiotics in reducing post-surgical infection complications.
A systematic review was conducted using PubMed, Cochrane, and Web of Science, adhering to PRISMA guidelines, focusing on antibiotic use in septoplasty, rhinoplasty, and SRP. The study included randomized control trials, single/double-blind studies, retrospective chart reviews, and prospective cohort studies, excluding pediatric, non-human research, or studies with inaccessible data. Postoperative infection rates were analyzed utilizing R software as a form of Statistic.
From 697 articles, 15 studies were chosen for meta-analysis, involving 2225 patients, with 1274 receiving prophylactic antibiotics and 951 as controls. The meta-analysis indicated an odds ratio of 0.65 (95 % CI: [0.23, 1.89]), showing no significant protective effect of prophylactic antibiotics.
The study found no significant infection rate reduction with prophylactic antibiotic use. Notable were inconsistencies in study designs, antibiotic administration timing, and varied surgical practices. Antibiotic use risks were considered. Study limitations include potential biases and the retrospective nature of many studies.
This review and meta-analysis found no substantial evidence supporting prophylactic antibiotics' effectiveness in reducing postoperative infection rates in septoplasty, rhinoplasty, and SRP, indicating a need to reevaluate practices and develop evidence-based guidelines. Future research should focus on comprehensive, randomized control studies, covering both preoperative and postoperative stages.
鼻中隔成形术和鼻成形术是常见的耳鼻喉科手术，通常联合施行鼻中隔成形术（septorhinoplasty，SRP），以提供美容和功能益处。由于鼻腔内存在天然细菌菌群，这些手术被认为可能有术后感染的风险。本研究评估预防性抗生素在降低术后感染并发症方面的效果。
使用 PubMed、Cochrane 和 Web of Science 进行系统综述，遵循 PRISMA 指南，重点关注鼻中隔成形术、鼻成形术和 SRP 中抗生素的使用。该研究纳入了随机对照试验、单盲/双盲研究、回顾性图表审查和前瞻性队列研究，排除了儿科、非人类研究或数据不可用的研究。使用 R 软件分析术后感染率，作为统计形式。
从 697 篇文章中，选择了 15 项进行荟萃分析，涉及 2225 名患者，其中 1274 名接受了预防性抗生素治疗，951 名为对照组。荟萃分析表明，预防性抗生素使用的优势比为 0.65（95%置信区间：[0.23，1.89]），没有显示出显著的保护作用。
本研究发现预防性抗生素使用并不能显著降低感染率。值得注意的是，研究设计、抗生素给药时间和手术实践存在差异。还考虑了抗生素使用的风险。研究的局限性包括潜在的偏倚和许多研究的回顾性性质。
本综述和荟萃分析没有发现支持预防性抗生素在鼻中隔成形术、鼻成形术和 SRP 中降低术后感染率方面有效性的实质性证据，表明需要重新评估实践并制定基于证据的指南。未来的研究应侧重于全面的、随机对照研究，涵盖术前和术后阶段。
