MRSA After Sinus Surgery. Am I More Prone to Infection in Future?

Question

I had sinus surgery 2 years ago and ended up with a pretty nasty infection that took about 5 months to get rid of. I was put on Cipro, bactrum, and few other antibiotics that I can't think of off the top of my head. Do I have a higher risk of getting another infection in the future?

Stephen Prendiville, MD · Answer

One of the major drawbacks of the over-use of antibiotics in human and animal populations is the development of drug resistant bacteria.  This represents more of an evolution of the bacteria to avoid being killed by specific antibiotics.  Furthermore, what was once a hospital phenomenon has now spread to the community at large in the United States and elsewhere, whereby percentages of populations are colonized with drug resistant bacteria.

	Given your history, I would suggest a nasal culture to rule out colonization with MRSA.  If there is no evidence of colonization, your risk of infection should be no greater than average.  One preoperative precaution taken in my practice is to have patients bathe in and apply Hibiclens (Chlorhexidine) to the operative sites the night before and the morning of the procedure.

Babak Larian, MD · Answer

Yes, you are more prone to infection in the future as MRSA has a tendency to stay in the nostril. The treatment is to use an antibiotic ointment called bactroban in the nostril for 6 weeks to ensure that the infection really is completely gone.

Mark Loury, MD, FACS (retired) · Answer

Sandy, As you know MRSA infections, which used to be mostly confined to institutions such as hospitals and nursing homes, are increasingly occuring in the community in otherwise healthy people.  Therefore it is difficult to know if your postoperative infection was from the place where you had your sinus surgery or it was acquired within your community.  These infections can be difficult to eradicate because the organism is often resistant to multiple other antibiotics, not just methicillin and its derivatives.  Nebulized vancomycin can be very effective. 

	However staphylococcus is notorious for forming biofilms which are bacterial colonies within a gel-like substance.  The bacteria stop reproducing but still can elaborate toxins that can damage the sinus linings causing them to lose cilia, the microscopic fingers that move mucous out of the sinuses.  Since antibiotics only kill dividing bacteria the organisms within the biofilm continue to survive.  That being said you might be more likely to have other infections based upon the continued presence of biofilms and the degree of permanent mucous membrane injury.  Some have advocated a dilute nasal irrigation solution of baby shampoo as the detergent action of the shampoo helps to break up the biofilm so that bacteria start reproducing again making them susceptible to destruction by antibiotics.  A long-winded answer to your question but I hope that helps.  Should MRSA recur try vancomycin nebs.

MRSA After Sinus Surgery. Am I More Prone to Infection in Future?

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