title: The value of microbiological screening in cleft lip and palate surgery.
abstract: OBJECTIVE
  This study was performed to investigate whether nasal and oropharyngeal microbiological swabs taken prior to cleft lip and palate surgery correlated with the oronasal flora at the time of surgery and whether specific culture results affected surgical outcome.
  
  
  METHODS
  Prospective audit set in two designated U.K. cleft centers each with a single surgeon. Nasal and oropharyngeal microbiological swabs were taken within 2 weeks prior to surgery and again on the operating table. Adverse outcome measures included postoperative pyrexia, wound dehiscence, or fistula formation.
  
  
  RESULTS
  One hundred forty-four cases were recruited over 12 months. Nasal swabs cultured organisms significantly more often than oropharyngeal swabs (p < .0001). No significant difference was detected in the number of cases with a positive microbiology culture preoperatively compared with perioperative sampling (48% and 50%). The specific organisms cultured from preoperative swabs were the same as those cultured at surgery in only half of cases. Preoperative microbiology swabs were poorly predictive of the oronasal flora at surgery. Antibiotic treatment of patients with positive preoperative microbiology did not significantly reduce the incidence of bacterial colonization or significantly alter clinical outcome.
  
  
  CONCLUSIONS
  Preoperative microbiological investigation is not helpful in predicting the nasal and oropharyngeal flora at the time of surgery. Further, culture results did not correlate with postoperative outcome, regardless of whether pre- or perioperative antibiotic therapy was instigated. This evidence suggests that microbiology screening swabs are an unnecessary investigation.
authors.affiliation: The Spires Cleft Lip & Palate Centre, Level 2, The Children’s Hospital, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom. gplthomas@gmail.com
authors.forename: Gregory P L
authors.initials: GP
authors.lastname: Thomas
authors.forename: Jane
authors.initials: J
authors.lastname: Sibley
authors.forename: Timothy E E
authors.initials: TE
authors.lastname: Goodacre
authors.forename: Michael M
authors.initials: MM
authors.lastname: Cadier
mesh_terms: D019072:Antibiotic Prophylaxis; D002675:Child, Preschool; D002971:Cleft Lip / Q000382:microbiology* / Q000601:surgery*; D002972:Cleft Palate / Q000382:microbiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013529:Surgical Wound Dehiscence / Q000382:microbiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control; D006113:United Kingdom