Preoperative Nasal Swab Research Articles

S294 – Pre-op Prevalence of MRSA in Intranasal Surgery Patients

Objectives 1) Understand the extent of methicillin-resistant Staphylococcus aureus among those undergoing intranasal surgery. 2) Be able to describe potential risk factors for MRSA colonization. The purpose of this study is to outline a prevalance of MRSA colonization among those undergoing inranasal surgery, with an exploration of potential risk factors for colonization. Methods Patients undergoing intranasal surgery (endoscopic sinus surgery, rhinoplasty, septoplasty, etc) at a tertiary care medical center had preoperative nasal swab cultures. The primary endpoint was positive culture of methicillin-resistant Staphylococcus aureus (MRSA). Patient demographic information was also collected to ascertain potential risk factors for colonization of MRSA. Results Early results have demonstrated that the prevalence of MRSA in patients is less than the reported prevalence in hospital inpatient populations. Of the initial 25 patients enrolled in this study, none were shown to be colonized with methicillin-resistant Staphylococcus aureus (0/25), with 1 patient having reported a history of MRSA infection (4%). Conclusions Preliminary data suggests that the prevalence of methicillin-resistant Staphylococcus aureus among patients undergoing intranasal surgery is less than the prevalence of inpatient populations as reported in several previous studies. While preliminary data suggests a potential decreased prevalence of MRSA in this population, a much larger sample of patients is needed to make a more definitive statement. In the coming weeks and months, as more data is gathered and the sample size included in the study grows, it will be interesting to note whether the initial trend, as suggested here, continues.

Does methicillin-resistantStaphylococcus aureushave a significant role in the peri-operative course of patients undergoing rhinological surgery?

Methicillin-resistant Staphylococcus aureus infections are becoming an increasing problem, but the link with symptomatic sino-nasal infection has not previously been quantified. The aim of this study was to determine the incidence of methicillin-resistant Staphylococcus aureus infection in patients undergoing sino-nasal surgery. A retrospective study of case notes. A district general hospital. One hundred and fifty-one adult patients undergoing in-patient endonasal surgery over a 12-month period were considered for the study. Swab results from pre-operative screening and from any intra- and post-operative samples of infective mucopus. One hundred and fifty-one patients undergoing endonasal surgery were included. All patients had pre-operative nasal swabs taken. Twenty-five patients had peri-operative microbiology samples taken. Only one middle meatal swab was found to contain methicillin-resistant Staphylococcus aureus. No patients had methicillin-resistant Staphylococcus aureus detected on pre-operative screening. Haemophilus influenzae was the most common organism detected. Methicillin-resistant Staphylococcus aureus infection does not represent a significant source of morbidity in our practice.

INVITED COMMENTARY

INVITED COMMENTARY

The microbiology of ethmoid and maxillary sinuses in patients with chronic sinusitis

Purpose: To investigate aerob-anearob microorganisms growth in maxillary and ethmoid sinuses by evaluating aspiration materials from patients with chronic sinusitis. Patients and Methods: The study was performed prospectively, and there were 31 patients (23 men, 8 women; mean age, 31.4±14.15, between 18-65 years) who had endoscopic sinus surgery because of chronic sinusitis. During the operation, when the maxillary sinus ostium and ethmoid sinus were opened, readily aspirated materials from sinuses were evaluated regarding aerob and anaerob bacteria. Nose and throat swap samples were collected preoperatively to determine the upper respiratory tract flora and also to understand the relationship between the flora and the microorganisms aspirated from sinuses. Results: Total aerob bacteria count, which was isolated from preoperative nasal swab cultures, was 36, and aerob-anaerob bacteria count that included cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery was 42. For each 2 samples, the most common isolated aerob bacteria were coagulase (−) staphylococci. Microorganisms were isolated in 87.0% of 27 patients, in which cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery were included. It is determined that the isolated aerob bacteria rate was 90.4%, and the isolated anaerob bacteria rate was 14.2%. All of the 6 samples in which anaerob bacteria isolated were all maxillary sinus aspiration materials. Microorganisms that isolated from the nose and the sinuses were similar with the rate of 25.8%, and microorganisms that isolated from the throat cultures and sinuses were similar with the rate of 22.5%. Conclusions: This study reveals the aerob and anaerob microbiology of the maxillary and ethmoid sinuses so the treatment of chronic sinusitis will be easier.

Risk factors for meningitis after trans-sphenoidal surgery for pituitary adenomas

Objective. Determinations of possible risk factors for postoperative meningitis in patients with pituitary tumours undergoing trans-sphenoidal surgery. Methods. Retrospective analysis of pre- and postoperative data on 228 patients having trans-septal transphenoidal pituitary gland surgery. Conventional radiographs of the paranasal sinuses were taken preoperatively. Bacterial survey of nasal swabs was undertaken. All patients received Amoxycillin for 6 days. Results. The incidence of meningitis was 3.1% (7/228). The average onset of first symptoms was 12 days (range 4–20 days) postoperatively. Meningitis was seen more in patients having Cushing’s disease (4/7). Preoperative nasal swabs had no predictive value for meningitis. Preoperative radiographs showed abnormalities in 28 patients of whom three patients suffered from sinusitis. Meningitis occurred in two of these threepatients. Intraoperative CSF-leakage was treated immediately with lumbar drainage. In none of these patients was meningitis seen. Postoperative CSF-leakage resulted ultimately in meningitis in six patients, despite adequate lumbar drainage. Conclusion. Postoperative CSF-leakage was the major risk factor for meningitis after transsphenoidal pituitary gland surgery, especially in patients with Cushing’s disease.