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In Reply.—We appreciate LCDR Kennedy's response to our article. His calculations based on the results of our questionnaire survey are, however, incorrect. Using his methods and assumptions, there were three, not seven, cases of toxic shock syndrome in 12013 patients not receiving systemic prophylaxis and no cases among 6184 patients who did receive such prophylaxis. The difference is not significant, and even if it were, it would have to be interpreted in view of the fact that patients were not randomly assigned to either group, and surgeons, surgical techniques, and procedures were not randomly distributed between the groups. Choice of antimicrobial agent, dose, timing, and route of administration were also not standardized.
We continue to believe, as we said in the article, that, "we did not identify any prophylactic or technical factors as having a protective effect, although a beneficial effect of topical or systemic prophylaxis was not excluded."
JACOBSON JA, KASWORM EM. Toxic Shock Syndrome After Nasal Surgery-Reply. Arch Otolaryngol Head Neck Surg. 1986;112(7):784. doi:10.1001/archotol.1986.03780070096022
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