title: Microbiology and antibiotic prophylaxis in rhinoplasty: a review of 363 consecutive cases.
abstract: OBJECTIVE
  A practical technique for reducing infectious complications from rhinoplasty would represent an important surgical advance.
  
  
  OBJECTIVE
  To describe the microbial flora of patients undergoing septorhinoplasty and to evaluate the role of preoperative and postoperative antibiotic prophylaxis.
  
  
  METHODS
  We performed a retrospective medical record review of 363 consecutive adult patients who underwent preoperative nasal swab testing and rhinoplasty or septorhinoplasty in a single private practice: 279 women (76.9%) and 84 men (23.1%). The average patient age was 35.9 years (age range, 17-70 years).
  
  
  METHODS
  Identification of endogenous nasal flora and pathogenic bacteria treated with culture-directed antibiotics; evaluation of comorbidities, perioperative infections, and antibiotic treatments.
  
  
  RESULTS
  A total of 174 patients (47.9%) underwent primary rhinoplasty, and 189 (52%) underwent revision rhinoplasty. On preoperative nasal culture, 78.2% of patients had normal flora; 10.7% had Staphylococcus aureus; and 0.28% had methicillin-resistant S aureus (MRSA). In 7.4% of patients, fecal coliforms including Escherichia coli, Enterobacter species, and Citrobacter species were found. Age, sex, smoking, the use of oral contraceptives, or the presence of seasonal allergies did not significantly change the nasal flora or the postoperative infection rate. Patients with adult acne were found to have an increased incidence of colonization with fecal coliforms (43.8%; P < .001). Patients with diabetes were found to have an increased incidence of colonization with S aureus (66.7%; P = .002). The overall infection rate was 3.0% (11 of 363 patients), with 4.0% (7 of 174 patients) seen in primary septorhinoplasties and 2.1% (4 of 189 patients) seen in revision cases. Coliforms accounted for 5 cases (45.5%) of postoperative infections, while S aureus was responsible for 4 cases (36.4%), including 1 case of MRSA.
  
  
  CONCLUSIONS
  The results of this study suggest that risk factors alone may not reliably predict the subset of patients in whom antibiotic prophylaxis is indicated. Knowledge of the endogenous nasal flora and the microbiology of common pathogens in patients undergoing septorhinoplasty will help to further reduce the incidence of infectious complications.
  
  
  METHODS
  3.
authors.affiliation: Facial Plastic Surgery, The Roxbury Institute, Beverly Hills, California2Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Southern California-Keck School of Medicine, Los Angeles3Depa.
authors.forename: Donald B
authors.initials: DB
authors.lastname: Yoo
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Southern California-Keck School of Medicine, Los Angeles.
authors.forename: Grace Lee
authors.initials: GL
authors.lastname: Peng
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, David Geffen School of Medicine at the University of California, Los Angeles4The Facial Paralysis Institute and the Center for Advanced Facial Plast.
authors.forename: Babak
authors.initials: B
authors.lastname: Azizzadeh
authors.affiliation: Facial Plastic Surgery, The Roxbury Institute, Beverly Hills, California2Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Southern California-Keck School of Medicine, Los Angeles.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Nassif
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008875:Middle Aged; D009666:Nose / Q000187:drug effects / Q000382:microbiology; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents