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Preoperative evaluation, culture-directed treatment reduces infection after rhinoplasty

Researchers reported that risk factors alone may not accurately predict the proportion of patients for whom antibiotic prophylaxis is recommended with regard to rhinoplasty procedures. However, preoperative evaluation and culture-directed treatment appeared to help reduce patients’ risk of infection.

The researchers retrospectively reviewed the medical records of 363 patients who underwent rhinoplasty or septorhinoplasty following preoperative nasal swab testing for age, rhinoplasty revision status, comorbid conditions, preoperative nasal carrier status and prophylaxis. They also recorded postoperative course, presence of infectious complications and any treatments administered.

All patients had received a prophylactic dose of intravenous cefazolin 1 g or clindamycin 450 mg within the 30 minutes prior to the first surgical incision. Postoperative follow-up occurred at 1 day, 1 week, 2 weeks, 1 month and at increasingly longer intervals thereafter. Any patient who showed signs or symptoms of active infection postoperatively were recultured and received antibiotics as appropriate.

Of the 363 patients studied, 284 showed normal nasal flora on preoperative cultures. Thirty-nine had Staphylococcus aureus and only one had Methicillin-resistant Staphylococcus aureus (MRSA).

Of the 174 primary rhinoplasty patients, 131 grew normal flora, 18 grew S. aureus and 27 grew coliforms. In the 189 revision patients, 153 grew normal flora, 21 grew S. aureus, 24 grew coliforms and one grew MRSA.

After surgery, presence of pain, discharge, foul odor, septal perforation and erythema led to reculturing. The overall postoperative infection rate was 3%, with 4% observed in primary septorhinoplasties and 2.1% observed in revision procedures, according to the researchers.

The researchers found age, sex, smoking status, oral contraceptive use and the presence of seasonal allergies were not associated with significant changes in nasal flora or postoperative infection rate. However, patients with acne had higher incidence of fecal coliforms, and those with diabetes were observed to have higher incidence of S. aureas colonization. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.