Funding sources for the study: National Institutes of Health, National Institute of Allergy and Infectious Diseases (NIAID) (K24 AI080942/AI/NIAID NIH HHS/United States to E.L.).
Culture-inappropriate antibiotic therapy decreases quality of life improvement after sinus surgery
Version of Record online: 10 JAN 2014
© 2014 ARS-AAOA, LLC
International Forum of Allergy & Rhinology
Volume 4, Issue 5, pages 403–410, May 2014
How to Cite
How to Cite this Article: Culture-inappropriate antibiotic therapy decreases quality of life improvement after sinus surgery. Int Forum Allergy Rhinol. 2014;4:403-410., , , et al.
Potential conflict of interest: E.L. received research grant support from Merck, AstraZeneca, and 3M. None of the other authors report any conflicts of interest.
- Issue online: 25 APR 2014
- Version of Record online: 10 JAN 2014
- Manuscript Accepted: 5 DEC 2013
- Manuscript Revised: 18 SEP 2013
- Manuscript Received: 18 MAY 2013
- National Institutes of Health
- National Institute of Allergy and Infectious Diseases (NIAID). Grant Number: K24 AI080942/AI/NIAID NIH HHS/United States
- antibiotic therapy;
- quality of life;
- endoscopic sinus surgery;
- chronic rhinosinusitis;
- 22-item Sinonasal Outcome Test
Despite their widespread use, antibiotics have not been shown to improve chronic rhinosinusitis (CRS) outcomes. We aimed to determine whether culture-inappropriate postoperative antibiotic therapy was associated with less quality-of-life (QOL) improvement following functional endoscopic sinus surgery (FESS).
This retrospective cohort study recruited 376 adult CRS patients undergoing FESS between October 1, 2007 to December 31, 2011. Patient demographics, comorbidities and medications were collected at baseline. Trimethoprim-sulfamethoxazole and clindamycin were administered for 2 weeks postoperatively. The antibiotic appropriateness was determined based on bacterial resistance profile of organisms identified during intraoperative culture. The QOL outcome was defined as change of 22-item Sinonasal Outcome Test scores from preoperative visit to 1-month, 3-month, and 6-month post-FESS. Clinically significant difference was defined as at least 0.5 standard deviations (SD) of baseline QOL score in the reference group. Mixed-effects regression models were performed.
Seven percent of patients (n = 27) had culture-inappropriate antibiotic therapy, and additional 5% (n = 19) had culture-specific antibiotic adjustment. Compared to patients with culture-appropriate antibiotics, patients with culture-inappropriate antibiotics had significantly less improvement of QOL from baseline to postoperative 1-month and 3-month follow-up where the difference became clinically significant; patients with antibiotic adjustment had more QOL improvement from baseline to 1-month follow-up, but their QOL worsened at 3-month follow-up, and these changes were not clinically significant. However, all effects washed out at 6-month follow-up with no significant differences.
Culture-inappropriate postoperative antibiotic therapy decreased short-term QOL improvement to a clinically meaningful level after FESS. Culture guided selection of antibiotics may improve short-term FESS outcome.