What patients are at risk for methicillin-resistant Staphylococcus aureus (MRSA) infection following septorhinoplasty and the need for antibiotic prophylaxis?
Background: Local infection is a rare complication following septorhinoplasty, but it has been suggested that at least half of the patients who undergo septorhinoplasty or rhinoplasty will be colonized with Staphylococcus aureus (S. aureus), and a percentage of those patients will be colonized with MRSA.
Study design: Literature review.
Setting: Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.
Synopsis: The authors reviewed and summarized several studies and reviews covering MRSA nasal carriage, MRSA in septorhinoplasty, prevention of MRSA infections following surgery and the role of antibiotics in septorhinoplasty. They said previous studies have shown that patients considered at increased risk of MRSA colonization include elderly patients over 60 years, particularly those in residential homes or rehabilitation units, those with previous hospital admissions or antibiotic use and patients who work in the health care setting (along with their household members). Regarding the role of antibiotics, the authors referred to two previous studies. The first study failed to demonstrate a difference between patients who received antibiotic prophylaxis during nasal surgery and those who did not. The second was a double-blinded randomized study of 100 patients in which the authors concluded that it is advisable to give prophylactic antibiotics in complicated revision rhinoplasty.
Bottom line: MRSA infections following rhinoplasty are exceedingly rare according to the literature. Those at risk include elderly patients over 60 years, particularly those in residential homes or rehabilitation units, those with previous hospital admissions or antibiotic use and patients who work in the health care setting (along with their household members). However, there remain no clear guidelines for prophylaxis for MRSA infection following rhinoplasty.
Citation: Angelos PC, Wang TD. Methicillin-resistant Staphylococcus aureus infection in septorhinoplasty. Laryngoscope. 2010;120(7):1309-1311.
—Reviewed by Sue PondromMulti-Page