Thursday, February 1, 2007
11972

Microbiologic Considerations for the Cleft Surgery Practice

John W. Antonetti, MD, John Heggars, and Steven J Blackwell M.D.

Purpose: Define changes in microbial flora before and after closure of the cleft palate and lip to better understand infection risk and justification for antibiotic usage.

Methods: Over a two year period forty-four patients receiving primary palatoplasty and ten patients receiving cheiloplasty were enrolled. The study involved pre and postoperative cultures from the nasal, sublingual, and oropharyngeal surface.

Results: 2.3 % of patients undergoing palatoplasty were positive for Streptococcus pyogenes ( group A B-hemolytic streptococci) preoperatively. Staph. aureus was present in 34% of patients preoperatively. MRSA prevalence increased from zero percent preoperatively to 4.5% of patients one year following surgery.

Potential gram negative pathogens (Klebsiella pneumoniae and Enterobacter cloacae) had preoperative prevalence of 34% and 22% within the oropharynx and were found to be significantly reduced one year following surgery.

Conclusion: Because group A B-hemolytic streptococci poses a high risk for palatal dehiscence, preoperative Rapid Strep screening should be a considered routine. Despite high prevalence of other potential pathogenic flora including Staph aureus and various enteric bacteria prior to palatoplasty, postoperative wound infection is rare in the prospective study population. Our data suggests that routine prophylactic antibiotics are unwarranted with primary cheiloplsty and palatoplasty when thorough preoperative screening is performed.