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Westman E, Höglund M, Nilsson FB, Bonnard Å, Englund E, Eriksson PO. Prophylactic antibiotics has no benefit for outcome in clean myringoplasty-A register-based cohort study from SwedEar. Clin Otolaryngol 2023; 48:895-901. [PMID: 37555629 DOI: 10.1111/coa.14089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVES To investigate if prophylactic antibiotics (PA) in conjunction with myringoplasty of clean and uninfected ears entails a reduction of postoperative infections within 6 weeks after surgery, and whether it affects the healing rate of the tympanic membrane (TM) at follow-up, 6-24 months after surgery. DESIGN A retrospective cohort study of prospectively collected data. SETTING Data extracted from The Swedish Quality Register for Ear Surgery (SwedEar), the years 2013-2019. PARTICIPANTS All patients in SwedEar with a registered clean conventional myringoplasty (tympanoplasty type I) including a follow-up visit. MAIN OUTCOME MEASURES The effect of PA use on TM healing rate at follow-up and postoperative infection within 6 weeks of surgery. RESULTS In the study group (n = 1665) 86.2% had a healed TM at follow-up. There was no significant difference between the groups that had PA administered (87.2%) or not (86.1%). A total of 8.0% had a postoperative infection within 6 weeks. Postoperative infection occurred in 10.2% of the group that received PA (n = 187) compared with 7.7% of the group that did not receive PA. However, this difference was not statistically significant. Postoperative infection within 6 weeks significantly lowered the frequency of healed TMs. CONCLUSION PA administered during clean conventional myringoplasty does not improve the chance of having a healed TM at follow up, nor decrease the risk of having a postoperative infection within 6 weeks after surgery.
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Affiliation(s)
- Eva Westman
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Sundsvall, Sweden
| | - Maria Höglund
- Department of Otorhinolaryngology, Surgical Division, County Council of Västernorrland, Sundsvall Hospital, Sundsvall, Sweden
| | - Frida Brännström Nilsson
- Department of Otorhinolaryngology, Surgical Division, County Council of Västernorrland, Sundsvall Hospital, Sundsvall, Sweden
| | - Åsa Bonnard
- Division of CLINTEC, Department of Otorhinolaryngology, Karolinska Institutet, Stockholm, Sweden
- MU ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
| | - Erling Englund
- Department of Research and Development, County Council of Västernorrland, Sundsvall Hospital, Sundsvall, Sweden
| | - Per Olof Eriksson
- MU ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
- Dept of Surgical Sciences, Otorhinolaryngology, Uppsala University Hospital, Uppsala, Sweden
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Torun MT. Usage of Surgical Antibiotic Prophylaxis in Routine Otolaryngologic Surgeries in Turkey. Int Arch Otorhinolaryngol 2022; 27:e123-e129. [PMID: 36714898 PMCID: PMC9879644 DOI: 10.1055/s-0042-1745727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/14/2022] [Indexed: 02/01/2023] Open
Abstract
Introduction: Inappropriate antibiotic use in the world leads to an increase in both health care costs and antibiotic resistance. Surgical antibiotic prophylaxis (SAP) is used by most surgeons, especially in the postoperative period. Objective The aim of the study is to determine the approach of ear, nose, and throat (ENT) specialists to surgical antibiotic prophylaxis in routine surgeries, and to raise awareness regarding inappropriate antibiotic use. Methods ENT specialists from all over Turkey participated in the study by filling out a data collecting form. The form consisted of 6 questions and was sent to specialists via email. Routine ENT operations such as adenoidectomy, tonsillectomy, adenotonsillectomy, ventilation tube application, septoplasty, rhinoplasty, septorhinoplasty (noncomplicated), tympanoplasty, and simple mastoidectomy were chosen for the study. Data were analyzed statistically. Results The form results of 110 ENT specialists were evaluated. The rate of participants who used and did not use SAP was 77.3% and 22.7%, respectively. The SAP usage rates of septoplasty, rhinoplasty, and septorhinoplasty operations were 84.7%, 81.2%, and 75.3%, respectively. For tympanoplasty and ventilation tube application operations, the rates were 82.4% and 24.7%, respectively. Finallly, the SAP usage rates of adenoidectomy, tonsillectomy, and adenotonsillectomy were 57.6%, 75.3%, and 72.9%, respectively. Conclusion Otolaryngological surgeries are often classified as clean or clean-contaminated surgeries. In most studies in the literature, it is reported that SAP use is unnecessary in routine otolaryngological surgery. Providing inservice training, regularly updating the prophylaxis guidelines and sharing these guidelines with surgeons may prevent inappropriate SAP use.
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Affiliation(s)
- Mümtaz Taner Torun
- Department of Otolaryngology, Bandirma Onyedi Eylul University, School of Medicine, Balıkesir, Turkey,Address for correspondence Mümtaz Taner Torun, MD Çanakkale Road 6th km. Bandırma/ Balıkesir 10500Turkey
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Li KL, Fang CH, Hawn VS, Agarwal V, Kshettry VR, Bellile E, Akbar NA, McKean EL, Abuzeid WM, Moskowitz HS. Antibiotic Use in Lateral Skull Base Surgery: A Survey of the North American Skull Base Society. J Neurol Surg B Skull Base 2022; 83:237-247. [PMID: 35769796 PMCID: PMC9236705 DOI: 10.1055/s-0040-1722642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/16/2020] [Indexed: 10/22/2022] Open
Abstract
Objectives Antibiotic use in lateral skull base surgery (LSBS) has not been thoroughly investigated in the literature. There is wide variability in antibiotic use and insufficient data to guide management. This study aims to describe the factors and patterns influencing antibiotic use in LSBS among the membership of the North American Skull Base Society (NASBS). Design An online-based survey was designed and distributed to the membership of the NASBS. Data was analyzed using bivariate analysis and logistic regression modeling. Setting Online-based questionnaire. Participants NASBS membership. Main Outcome Measures Use of intraoperative antibiotics and use of postoperative antibiotics. Results The survey response rate was 26% (208 respondents). Of the 208 total respondents, 143 (69%) respondents performed LSBS. Most respondents are neurosurgeons (69%) with the remaining being otolaryngologists (31%). The majority of respondents (79%) are fellowship-trained in skull base surgery. Academic or government physicians make up 69% of respondents and 31% are in private practice with or without academic affiliations. Bivariate analysis showed that practice setting significantly influenced intraoperative antibiotic use ( p = 0.01). Geographic location significantly affected postoperative antibiotic use ( p = 0.01). Postoperative antibiotic duration was significantly affected by presence of chronic otitis media, cerebrospinal fluid leak, and surgeon training ( p = 0.02, p = 0.01, and p = 0.006, respectively). Logistic regression modeling showed that the motivation to reduce infection significantly impacted postoperative antibiotic use ( p = 0.03). Conclusion This study demonstrates significant variations in intraoperative and postoperative antibiotic use in LSBS among the NASBS membership. Appropriate guidelines for optimal perioperative antibiotic use patterns should be determined with randomized studies in the future.
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Affiliation(s)
- Kevin L. Li
- Department of Otorhinolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Christina H. Fang
- Department of Otorhinolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Vivian S. Hawn
- Department of Otorhinolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Vijay Agarwal
- Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Varun R. Kshettry
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, United States
| | - Emily Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States
| | - Nadeem A. Akbar
- Department of Otorhinolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Erin L. McKean
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Waleed M. Abuzeid
- Department of Otolaryngology – Head and Neck Surgery, University of Washington, Seattle, Washington, United States
| | - Howard S. Moskowitz
- Department of Otorhinolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
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Yalamanchi P, Parent A, Thorne M. Optimization of Delivery of Pediatric Otolaryngology Surgical Antibiotic Prophylaxis. Otolaryngol Head Neck Surg 2020; 163:275-279. [PMID: 32571162 DOI: 10.1177/0194599820933191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES There is limited evidence regarding use of routine perioperative antibiotics for pediatric otolaryngologic procedures. The objectives of this quality improvement study were (1) to characterize the otolaryngology case mix for which antibiotics were delivered and (2) determine the percentage of surgical encounters with appropriate timing of antibiotic administration. METHODS Pediatric otolaryngology procedures meeting criteria from 2015 to 2019 were evaluated as a component of an institution-wide pediatric surgical antibiotic prophylaxis study using A3 problem solving to identify and roll out interventions for appropriate antibiotic administration. Descriptive statistical analysis of the interrupted time-series data was used to describe the otolaryngology case mix for which antibiotics were delivered. The primary outcome measure was percentage of surgical encounters with appropriate timing of antibiotic administration in minutes relative to incision. RESULTS In total, 1520 pediatric otolaryngology procedures with perioperative antibiotic delivery were performed from July 2015 to September 2019. While surgical site infection number (n = 2/year) was stable, administration of timely prophylactic antibiotics significantly improved: 27.5% of cases per month at baseline and 86.9% at the conclusion of the rollout of the sequential interventions (P < .001). DISCUSSION Given the exceedingly low infection rate of clean otolaryngology surgery, there is limited evidence in favor of perioperative antibiotics for the majority of procedures. Prophylactic antibiotics were most commonly used in otologic surgery involving cochlear implantation or in the setting of draining ears or cholesteatoma and in clean-contaminated head and neck surgery cases. IMPLICATIONS FOR PRACTICE Iterative continuous performance improvement can optimize evidence-based delivery of preoperative prophylactic antibiotics. Additional interventions to ensure antimicrobial stewardship in pediatric otolaryngology are indicated.
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Affiliation(s)
- Pratyusha Yalamanchi
- Department of Otolaryngology, Head & Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashley Parent
- CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc Thorne
- Department of Otolaryngology, Head & Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Roof SA, Ferrandino RM, Villavisanis DF, Amato MV, Rubinstein BJ, Courey MS, Woo P. Infection Rates After Microlaryngeal and Open Phonosurgery: The Role of Postoperative Antibiotics. Laryngoscope 2019; 130:1128-1131. [PMID: 31424561 DOI: 10.1002/lary.28225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/26/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although it is known that the airway has bacterial contamination that seeds the surgical site during microlaryngeal surgery, literature on the use of postoperative antibiotics is lacking. We performed a retrospective analysis of open phonosurgical and phonomicrosurgical cases at a single institution to assess whether use of postoperative antibiotics impacts the incidence of surgical site infections (SSI). METHODS In this retrospective cohort study, we reviewed 228 phonomicrosurgery and 53 open phonosurgery cases performed for benign diseases. Surgeries were performed by two laryngologists between February 2016 and August 2018. The surgeons differ in their postoperative antibiotic regimens: no antibiotics versus a 5- to 7-day postoperative course. Data collected include demographics, medical comorbidities, type of benign laryngeal disease, and surgical procedure. The primary outcome measure was postoperative infection, defined as the patient requiring a new prescription for antibiotics, an extended course of antibiotics, or any mention of infection at follow-up/emergency visits within the first month postoperatively. RESULTS The overall rate of SSI was 3.1% and 0% for phonomicrosurgery and open phonosurgery cases, respectively. For phonomicrosurgery, there was no difference in the rate of SSI for patients who received or did not receive antibiotics perioperatively: 2.9% versus 3.2% (P = 0.99). Similarly, there was no difference in the infection rate for open phonosurgical cases. CONCLUSION Infection rates after endoscopic and open phonosurgery are low. In this study, we found no evidence to suggest a protective effect associated with postoperative use of antibiotics. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1128-1131, 2020.
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Affiliation(s)
- Scott A Roof
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Rocco M Ferrandino
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | | | - Michael V Amato
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Benjamin J Rubinstein
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Mark S Courey
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Peak Woo
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York, U.S.A
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Yetzke M, Heyes R, Nakra N, Merea VS, Lott D, Clary MS, Bryson P, Verma SP. Are Perioperative Antibiotics Necessary During Direct Microlaryngoscopy? Laryngoscope 2018; 128:2838-2843. [PMID: 30325026 DOI: 10.1002/lary.27308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/03/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES/HYPOTHESIS There are currently no established recommendations for the use of perioperative antibiotics (PAs) to prevent surgical site infections (SSIs) for direct microlaryngoscopy (DML). This study examined the incidence of SSI in patients undergoing DML with and without PAs. STUDY DESIGN Retrospective, multi-institutional chart review. METHODS A retrospective, multi-institutional chart review was performed at four tertiary referral academic medical centers. Patients undergoing DML from 2010 to 2017 were identified using Current Procedural Terminology codes. Medical records of patients undergoing DML with biopsy, microsurgery, laser ablation, or vocal fold injection who had adequate follow-up were reviewed. Procedures with significant cartilage destruction, concurrent open surgery, or esophageal surgery were excluded. Data recorded included age, gender, pacemaker history, American Society of Anesthesiologists class, wound class, indication for surgery, use of laser, complications, emergency room visits, hospitalizations, pain, fever, and postoperative steroid and antibiotic prescriptions. Presence or absence of SSIs was evaluated by a fellowship-trained laryngologist. RESULTS There were 834 patients who met inclusion criteria. Of those, 698 did not receive PAs and 136 received PAs. The median age of patients was 54 years of age in the PA group and 57.5 years of age in the non-PA group, and all cases were recorded as wound class II. Overall, 58% of surgeries involved use of carbon dioxide or potassium-titanyl-phosphate laser. Only one SSI was reported on follow-up in a patient who did receive PAs. CONCLUSIONS SSIs are exceedingly rare following DML. PA use is not indicated for routine DML. LEVEL OF EVIDENCE 4 Laryngoscope, 128:2838-2843, 2018.
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Affiliation(s)
- Megan Yetzke
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine School of Medicine, Irvine, California
| | - Richard Heyes
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Natasha Nakra
- Department of Pediatrics, Division of Infectious Diseases, University of California Davis, Sacramento, California
| | - Valeria Silva Merea
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio
| | - David Lott
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Matthew S Clary
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Paul Bryson
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Sunil P Verma
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine School of Medicine, Irvine, California
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Patel PN, Jayawardena ADL, Walden RL, Penn EB, Francis DO. Evidence-Based Use of Perioperative Antibiotics in Otolaryngology. Otolaryngol Head Neck Surg 2018; 158:783-800. [DOI: 10.1177/0194599817753610] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Priyesh N. Patel
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Rachel L. Walden
- Annette and Irwin Eskind Biomedical Library, Vanderbilt University, Nashville, Tennessee, USA
| | - Edward B. Penn
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David O. Francis
- Division of Otolaryngology, Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
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Influence of a strictly perioperative antibiotic prophylaxis vs a prolonged postoperative prophylaxis on surgical site infections in maxillofacial surgery. Infection 2017; 46:225-230. [PMID: 29250713 DOI: 10.1007/s15010-017-1110-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/12/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE The adequate perioperative antibiotic prophylaxis in maxillofacial surgery is still under discussion due to the wide range of hard and soft tissue procedures as well as contaminated, semi-contaminated and clean surgical sides. Perioperative antibiosis is an easy applicable tool that can be used to decrease nosocomial morbidity and mortality by reducing the rate of infections. We compared strictly perioperative antibiosis with an extended postoperative prophylactic antibiosis. MATERIALS AND METHODS In this study, 901 consecutive patients, from a tertiary care maxillofacial surgery department were included and distributed into two groups: The first group received peri- and postoperative antibiotic prophylaxis (PP; n = 365) from the day of operation until the fifth day postoperatively. The second group was treated with single shot prophylaxis with intraoperative repetition as needed (SSP; n = 536) only. Furthermore, the patients were grouped according to their main diagnosis and surgical procedure. For comparison, general anamnestic data, cultured bacteria and resistances, number of surgical site infections and duration of hospitalization were compared. RESULTS There were no statistically significant differences in general diseases or extent of surgery between the groups. There was no statistical difference in the surgical site infections between the groups regardless of their diagnosis. There were significant correlations between tracheotomised patients (p < 0.001) as well as patients with a higher BMI (p = 0.009) and the incidence of surgical site infections. Most common cultured bacteria were staphylococci. CONCLUSION Based on the findings of the study, we believe that a perioperative antibiosis delivers a sufficient prophylaxis for patients undergoing maxillofacial surgery procedures.
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Krouse JH. Highlights from the current issue: January 2015. Otolaryngol Head Neck Surg 2015; 152:3-4. [PMID: 25548211 DOI: 10.1177/0194599814558829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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