Review: No support for use of postoperative antibiotics after rhinoplasty
A systematic review and meta-analysis published today in JAMA Facial Plastic Surgery suggests there's no evidence to support routine use of postoperative antibiotics after rhinoplasty procedures.
The review and meta-analysis of five randomized clinical trials involving a pooled sample of 589 patients found that postoperative antibiotic therapy did not significantly alter the rate of infections after rhinoplasty procedures when compared with preoperative or perioperative antibiotics or with placebo or no treatment. The pooled risk ratio (RR) for infection when comparing postoperative antibiotics with any or all other antibiotic regimens in the trials—including preoperative, perioperative, or placebo or no treatment—was 0.92 (95% confidence interval [CI], 0.35 to 2.43, P = .86). When comparing postoperative antibiotics with placebo or no treatment, the pooled RR was 0.43 (95% CI, 0.18 to 1.04, P = .06).
"The differences in RRs of infection were not statistically significant when comparing postoperative with preoperative and perioperative antibiotics or with placebo," the authors of the review write.
According to the review, the use of antibiotics following rhinoplasty to avoid infection is widespread, occurring in more than 90% of procedures. Yet several studies have found that the rate of infection after rhinoplasty is low, and evidence on the effectiveness of antibiotic prophylaxis is mixed. This is the first meta-analysis on the topic.
The authors conclude that, despite the findings, surgeons should still take into account a variety of factors when evaluating infection risk, including the scope of the surgery, the length, and the use of grafts or foreign materials. "It shall remain important to be vigilant regarding infection risk, and the above recommendations are not a replacement for clinical judgement on a case-by-case basis," they write.
Nov 29 JAMA Facial Plast Surg study
French study finds rapid flu test in children may cut antibiotic use, costs
A study by French researchers published yesterday in Clinical Microbiology and Infection found that bedside use of a rapid flu diagnostic test in children with flu-like symptoms was tied to significantly reduced invasive tests, antibiotic treatment, and hospitalization.
In the prospective study, conducted in the pediatric emergency department of a French academic medical center, the researchers used a rapid influenza digital immunoassay (DIA) to detect influenza virus A and B antigens in nasopharyngeal aspirates from children with flulike symptoms. To evaluate the sensitivity, specificity, and negative and positive predictive values of the DIA, they tested the same samples with standard immunofluorescence and molecular assays.
Before using the DIA, clinicians filled out questionnaires listing the tests and treatments they would have prescribed for the children in the absence of rapid testing. The researchers then compared those answers with what was done after using the DIA. They also compared the actions taken after using the DIA with data obtained from the three previous winter seasons.
Among the 512 patients included in the study, the DIA results showed that 245 tested negative for flu and 269 tested positive. When compared with the standard tests, the sensitivity, specificity, and negative and positive and predictive values of the DIA were 95.9%, 95.2%, 95.6%, and 95.5%, respectively. When the researchers compared the actions performed during the study period with the three previous winter seasons, they observed that use of the DIA at bedside was associated with a reduction in antibiotic treatments of 70% (from 16.9% to 5.1%), prescription of blood puncture of 77.8% (21.2% to 6.6%), chest x-rays of 69% (33.3% to 10.3%), lumbar puncture of 77.8% (7% to 1.6%), and hospitalization of 25.0% (27.2% to 20.4%). Reduction of medical costs was estimated to be more than €69,000 ($78,476) per season.
"In addition to delivering a rapid aetiological diagnosis, this strategy is able to save the prescription of a considerable number of unnecessary tests, antimicrobial treatments, and hospital stay," the authors of the study write. They suggest further studies are needed to confirm the results.
Nov 28 Clin Microbiol Infect abstract
CDC announces funding for antimicrobial resistance projects
The US Centers for Disease Control and Prevention (CDC) announced this week that it has awarded more than $15 million in 2018 to 41 innovative projects to combat antimicrobial resistance.
Among the recipients of the CDC funds are Rush University, which is studying factors associated with Candida auris colonization in healthcare settings, and the Children's Hospital of Philadelphia, where researchers are working on a novel metric for benchmarking antibiotic use to inform outpatient stewardship efforts. Other projects include a Washington University in St. Louis study on the effects of antibiotics on infant microbiomes and Iowa State University research on multidrug-resistant Campylobacter in dogs.
The projects are being supported through the CDC's Antimicrobial Resistance Solutions Initiative, which fund efforts to improve the national infrastructure for detecting, containing, and preventing resistant infections in healthcare settings, food, and the community.
Nov 26 CDC Broad Agency Announcement