Prevention of wound dehiscence in palatal surgery by preoperative identification of group A Streptococcus and Staphylococcus aureus.

The goal of this study was to assess the effectiveness of the selective use of prophylactic antibiotics after preoperative microbiological analysis of the oral and nasal cavity. In a retrospective study of wound infections after palatal surgery, 124 patients were included (134 procedures) who underwent all types of corrections of the palate. Standardized cultures from nasal and oropharyngeal mucosa were routinely obtained from all patients admitted for palatal surgery in the week prior to operation. According to existing protocol, every patient revealing group A Streptococcus from the nose or the throat received intravenous amoxicillin-clavulanate perioperatively. The postoperative finding of the combination of partial or complete wound dehiscence, pus, and fever was considered evidence of infection. Cultures from dehisced wounds were subsequently analyzed. Out of 134 procedures performed with this selective use of antibiotics, an infection rate of 6.0% (eight procedures) was noted. None of the patients receiving the amoxicillin-clavulanate prophylaxis showed infection. Patients showing infection revealed preoperative cultures with a diverse flora. Postoperative cultures of these patients showed group A Streptococcus and Staphylococcus aureus as the main pathogens. Despite the retrospective design and limited number of infected patients, cautious conclusions are warranted. When routine cultures from the nasal and oropharyngeal mucosa are obtained preoperatively, infection rate may be reduced by selective use of antibiotics against group A Streptococcus and Staphylococcus aureus. [ABSTRACT FROM AUTHOR]