Microbiology and antibiotic prophylaxis in rhinoplasty: a review of 363 consecutive cases

Overview

Infection after rhinoplasty is uncommon but costly, and surgeons disagree on who should receive preventive antibiotics. The authors reviewed 363 adults swabbed before rhinoplasty or septorhinoplasty in one private practice, to describe what bacteria live in these noses and whether risk factors predict infection.

Sections of note

• 363 consecutive adults, 279 women and 84 men, average age 35.9 years, range 17 to 70.
• 174 patients (47.9 percent) had primary and 189 (52 percent) had revision rhinoplasty.
• Preoperative cultures: 78.2 percent normal flora, 10.7 percent Staphylococcus aureus, 0.28 percent methicillin-resistant S aureus.
• Fecal coliforms including Escherichia coli, Enterobacter and Citrobacter were found in 7.4 percent of patients.
• Age, sex, smoking, oral contraceptive use and seasonal allergies did not significantly change nasal flora or infection rate. Adult acne was linked to coliform carriage (43.8 percent, p less than 0.001) and diabetes to S aureus carriage (66.7 percent, p = 0.002).
• Overall infection rate 3.0 percent (11 of 363), 4.0 percent in primary and 2.1 percent in revision cases. Coliforms caused 5 infections and S aureus 4, including one MRSA case.

What it means for a patient

• Infection after rhinoplasty was rare in this series, affecting about three in every hundred patients.
• Most people carry ordinary nasal bacteria, but a minority carry organisms that would not respond to the usual preventive antibiotic.
• Common risk factors such as smoking or allergies did not predict who became infected, so screening by history alone is unreliable.
• This is one private practice reviewed retrospectively with no untreated comparison group, so it cannot prove that swabbing lowers infection rates.

Why this paper matters

It challenges the habit of choosing antibiotic cover by patient risk profile and argues instead for knowing the actual bacteria present. The finding that coliforms caused most infections is the practical point, since standard prophylaxis targets staphylococci. Whether routine preoperative culture reduces infections in practice is untested.

Terms

• Antibiotic prophylaxis: antibiotics given to prevent infection rather than treat one.
• Nasal flora: the bacteria that normally live inside the nose without causing illness.
• Staphylococcus aureus: a common skin and nasal bacterium and a frequent cause of surgical infection.
• MRSA: a strain of S aureus resistant to standard penicillin-type antibiotics.
• Coliforms: gut-type bacteria such as E coli, not normally expected in the nose.