Culture-inappropriate antibiotic therapy decreases quality of life improvement after sinus surgery

Zi Zhang, James N. Palmer, Knashawn H. Morales, Timothy J. Howland, Laurel J. Doghramji, Nithin D. Adappa, Alexander G Chiu, Noam A. Cohen, Ebbing Lautenbach

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: 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). Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)403-410
Number of pages8
JournalInternational Forum of Allergy and Rhinology
Volume4
Issue number5
DOIs
StatePublished - 2014

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Quality Improvement
Quality of Life
Anti-Bacterial Agents
Therapeutics
Clindamycin
Sulfamethoxazole Drug Combination Trimethoprim
Comorbidity
Cohort Studies
Retrospective Studies
Demography

Keywords

  • 22-item Sinonasal Outcome Test
  • Antibiotic therapy
  • Chronic rhinosinusitis
  • Culture
  • Endoscopic sinus surgery
  • Quality of life
  • SNOT-22

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology
  • Medicine(all)

Cite this

Zhang, Z., Palmer, J. N., Morales, K. H., Howland, T. J., Doghramji, L. J., Adappa, N. D., ... Lautenbach, E. (2014). Culture-inappropriate antibiotic therapy decreases quality of life improvement after sinus surgery. International Forum of Allergy and Rhinology, 4(5), 403-410. https://doi.org/10.1002/alr.21277

Culture-inappropriate antibiotic therapy decreases quality of life improvement after sinus surgery. / Zhang, Zi; Palmer, James N.; Morales, Knashawn H.; Howland, Timothy J.; Doghramji, Laurel J.; Adappa, Nithin D.; Chiu, Alexander G; Cohen, Noam A.; Lautenbach, Ebbing.

In: International Forum of Allergy and Rhinology, Vol. 4, No. 5, 2014, p. 403-410.

Research output: Contribution to journalArticle

Zhang, Z, Palmer, JN, Morales, KH, Howland, TJ, Doghramji, LJ, Adappa, ND, Chiu, AG, Cohen, NA & Lautenbach, E 2014, 'Culture-inappropriate antibiotic therapy decreases quality of life improvement after sinus surgery', International Forum of Allergy and Rhinology, vol. 4, no. 5, pp. 403-410. https://doi.org/10.1002/alr.21277
Zhang, Zi ; Palmer, James N. ; Morales, Knashawn H. ; Howland, Timothy J. ; Doghramji, Laurel J. ; Adappa, Nithin D. ; Chiu, Alexander G ; Cohen, Noam A. ; Lautenbach, Ebbing. / Culture-inappropriate antibiotic therapy decreases quality of life improvement after sinus surgery. In: International Forum of Allergy and Rhinology. 2014 ; Vol. 4, No. 5. pp. 403-410.
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abstract = "Background: 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). Methods: 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. Results: 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. Conclusion: 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.",
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AU - Palmer, James N.

AU - Morales, Knashawn H.

AU - Howland, Timothy J.

AU - Doghramji, Laurel J.

AU - Adappa, Nithin D.

AU - Chiu, Alexander G

AU - Cohen, Noam A.

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AB - Background: 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). Methods: 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. Results: 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. Conclusion: 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.

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