Impaired mucosal healing and infection associated with Staphylococcus aureus after endoscopic sinus surgery.
BACKGROUND
Differentiating normal nasal discharge and postoperative crust from infection after endoscopic sinus surgery (ESS) can be difficult. We investigated whether bacteria cultured at operation was predictive for postoperative mucosal infection-defined as frank pus, thick mucus, and/or abnormal crusting seen on endoscopic examination associated with positive microbiology.


METHODS
The records of 48 patients with chronic rhinosinusitis (CRS) with infection at the time of ESS were retrospectively reviewed. Results of intraoperative cultures were compared with those taken at the time of postoperative mucosal infection.


RESULTS
Fourteen of 16 patients (87.5%) with intraoperative infection with Staphylococcus aureus progressed to postoperative mucosal infection with S. aureus, whereas patients who cultured "other" bacteria intraoperatively progressed to postoperative mucosal infection in 6/19 cases (31.6%), with S. aureus cultured in only 3/19 cases (15.8%; p=0.0001).


CONCLUSIONS
S. aureus infection at ESS predicts for abnormal, S. aureus-associated mucosal healing and infection post-ESS. Although a prospective trial is warranted, these findings suggest a future role for aggressive anti-S. aureus therapy peri- and/or postoperatively in patients who culture positive for this organism to improve postsurgical outcomes.
Jervis-Bardy
Joshua
J
Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
Foreman
Andrew
A
Field
John
J
Wormald
Peter John
PJ
D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009093:Mucus / Q000382:microbiology*; D009297:Nasal Mucosa / Q000382:microbiology* / Q000601:surgery; D010256:Paranasal Sinuses / Q000382:microbiology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology; D016896:Treatment Outcome; D014945:Wound Healing