Nasal Decontamination Research Articles

Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment

In spite of advances in the management of mediastinitis following sternotomy, mediastinitis is still associated with significant morbidity. The prognosis is much better in pediatric surgery compared to adult surgery, but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated. Prevention includes nasal decontamination, skin preparation, antibioprophylaxis and air filtration in the operating theater. The expertise of the surgical team is an additional factor that is difficult to assess precisely. Diagnosis is often very simple, being made on the basis of a septic state with wound modification, while retrosternal puncture and CT scan are rarely useful. Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy. Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined. However, we suggest that a primary sternal closure is the best surgical option for pediatric patients. We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy, which thus decreases physiological and psychological trauma for patients and families. We have demonstrated the efficiency of this technique, which is also cost-effective by decreasing intensive care and hospital stay durations, in a large group of patients.

Decontaminating the nasal passages.

Nasal decontamination may be indicated when the anterior nasal passages are contaminated with highly radioactive material or radioactive material with either irritating or toxic properties. Nasal irrigation (wash, rinse, douche, lavage) is an established technique used for other conditions and can be applied in these cases. This paper discusses the rationale and use of nasal irrigation and how to perform the technique.

Does Nasal Decontamination Using Muporicin Reduce the Incidence of Infections after Cardiac Surgery?

Does Nasal Decontamination Using Muporicin Reduce the Incidence of Infections after Cardiac Surgery?

Staphylococcus aureus nasal carriage in 104 cirrhotic and control patients A prospective study

Background/Aims: Bacterial infections, specially Staphylococcus aureus (S. aureus) septicemia, remain a leading cause of death following liver transplantation. It has been demonstrated that nasal carriage of S. aureus is associated with invasive infections in patients undergoing hemodialysis and could be decreased by use of antibiotic nasal ointment. However, in cirrhotic patients, the frequency of nasal carriage is unknown. The aims of this study were to determine the prevalence of S. aureus nasal carriage in cirrhotic patients and to assess nosocomial contamination.Methods: One hundred and four patients were included in a prospective study, 52 cirrhotic and 52 control (hospitalized patients without cirrhosis or disease which might increase the rate of nasal carriage of S. aureus). On admission and after a few days of hospitalization, nasal specimens from each anterior naris were obtained for culture. S. aureus was identified by the gram strain, positive catalase and coagulase reactions; antibiotic susceptibility was determined using a disk-diffusion test.Results: Both groups were similar with regard to age and sex. The prevalence of nasal colonization on hospital admission was 56% in cirrhotic patients and 13% in control patients (p=0.001). After an average of 4 days, 42% of cirrhotics and 8% of control patients were colonized (p=0.001), without any nosocomial contamination. Three strains out of 29 were oxacillin-resistant in cirrhotic patients, and none in controls (p>0.05). There was no statistical difference in carriage rate according to sex, age, cause of cirrhosis and Child-Pugh score. Previous hospitalization (OR, 6.3; 95% CI, 2.3 to 19.9; p=0.0006) and cirrhosis (OR, 4.4; 95% CI, 1.5 to 13.4; p=0.0048) were independent predictors of colonization.Conclusion: Cirrhotic patients had a higher S. aureus nasal carriage rate than control subjects. Previous hospitalization and cirrhosis diagnosis were correlated to nasal colonization. Further studies are necessary to determine if nasal decontamination could reduce S. aureus infections after liver transplantation.

Ｍｕｐｉｒｏｃｉｎ鼻腔用軟膏の三次救急医療施設におけるＭＲＳＡ感染症発症防止効果の検討

In the intensive care unit (ICU) for critical care, there is a high incidence of methicillin resistant Staphylococcus aureus (MRSA) outbreaks by cross infection when MRSA carriers happen to be in the ICU. A hospital infection of MRSA causes particular problems because of the high cost of treatment and prophylaxis. We examined the effects of mupirocin calcium hydrate nasal ointment (MUP) to eliminate MRSA infection by applying it to all patients who were admitted to our critical care ward. During the study period, a historical control phase, a placebo-controlled phase (phase-I) and a phase for blanket use of MUP (phase-II) lasted 4, 8, and 4 months, respectively. A significantly lower rate of MRSA infection in the group using MUP (n=243) was noted in comparison with the historical control group (n=121) (0.4% and 6.6% respectively; p=0.0110). In phase-I, only one MRSA infection was documented in the MUP group compared to 7 in the placebo group (p=0.025). An analysis of the costs showed a significant difference in the average cost of the drugs for MRSA infection per patient in the historical control period and phase-II (¥14, 698 and ¥376 respectively; p<0.0001). In conclusion, nasal decontamination using MUP on admission to the ICU for critical care was found to be effective in eliminating MRSA infections. In addition, this regimen was considered to be a cost-effective solution for the MRSA problem because of the significant reduction in the drug cost for MRSA infection.

Outbreak among HIV-infected patients of Staphylococcus aureus resistant to cotrimoxazole and methicillin.

To describe an outbreak of trimethoprim-sulfamethoxazole (cotrimoxazole)-resistant and methicillin-resistant Staphylococcus aureus (CMRSA) in a unit housing patients infected with the human immunodeficiency virus (HIV). Prospective study involving patients colonized or infected with CMRSA. 15 hospitalized patients with cultures positive for CMRSA. Isolates of CMRSA were collected and characterized. Molecular typing of the epidemic strains was carried out after total DNA extraction by restriction endonuclease analysis and random amplification of polymorphic DNA. The epidemic was brought under control with the reinforcement of nosocomial transmission measures and with systematic nasal decontamination with mupirocin of all patients admitted to the HIV unit. Molecular typing techniques showed the existence of two epidemic strains: strain A was present in the 12 patients admitted to the HIV unit and strain B in the remaining 3 patients hospitalized elsewhere. Cotrimoxazole may no longer be a reliable and effective alternative for glycopeptides in patients with infection caused by MRSA strains, and HIV units should be particularly alert for CMRSA strains.

Nasal carriage of Staphylococcus aureus and cross-contamination in a surgical intensive care unit: efficacy of mupirocin ointment

A six month prospective study was carried out in a surgical intensive care unit (SICU) of a university hospital to assess the incidence and routes of exogenous colonization by Staphylococcus aureus. A total of 157 patients were included in the study. One thousand one hundred and eleven specimens (nasal, surgical wound swabs, tracheal secretions obtained on admission and once a week thereafter, and all clinical specimens) were collected over a four month period from patients without nasal decontamination (A). They were compared with 729 specimens collected over a two month period from patients treated with nasal mupirocin ointment (B). All S. aureus strains were typed by restriction fragment length polymorphism (RFLP) pulsed-field gel electrophoresis after SmaI macrorestriction. The nasal colonization rates on admission were 25·5 and 32·7% in groups A and B, respectively. Thirty-one untreated patients (31·3%) and three patients (5·1%) treated with nasal ointment, acquired the nasal S. aureus in the SICU ( P = 0·00027). Nasal carriers were more frequently colonized in the bronchopulmonary tract (Bp) and surgical wound (Sw) (62%) than patients who were not nasal carriers (14%) ( P < 0·00001). The patterns were identical for nasal, Bp and Sw strains from the same patient. RFLP analysis characterized seven epidemic strains of methicillin-resistant S. aureus (MRSA) which colonized 60% of group A and 9% of group B patients ( P < 0·00001). The bronchopulmonary tract infection rate was reduced in group B ( P = 0 · 032). In conclusion, in an SICU, nasal carriage of S. aureus appeared to be the source of endogenous and cross-colonization. The use of nasal mupirocin ointment reduced the incidence of Bp and Sw colonization, as well as the MRSA infection rate.