Preoperative Systemic Antimicrobial Prophylaxis in Contaminated Middle Ear Surgery for Cholesteatoma

Abstract

Objectives:

Evaluate the efficacy of combined anti-staphylococcal and anti-pseudomonal preoperative antibiotics for preventing surgical site infections following tympanoplasty and mastoidectomy (TM) with contaminated cholesteatoma.

Methods:

Study Design: Retrospective chart review Method: Medical records of patients who underwent TM for cholesteatoma were reviewed. Only cases considered to have contaminated or dirty/infected surgical fields were included. Patients were excluded if there was preexisting infection or intraoperative finding requiring systemic antibiotic therapy. The primary outcome measure was postoperative perichondritis, pinna abscess, peri-otic cellulitis, and peri-otic abscess requiring systemic antibiotics or surgical intervention.

Results:

The charts of 362 patients who underwent TM were reviewed. 195 met inclusion criteria. Preoperative antibiotics included clindamycin and ceftazidime or gentamicin. Patients treated with no perioperative antibiotics had an infection rate of 11% and those treated with perioperative antibiotics had a rate of 1% (P = .02).

Conclusions:

The use of preoperative antibiotics to cover staphylococcal and pseudomonal species prevented surgical site infections as compared to no perioperative antibiotics.