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J. D. Benevento, T. J. Alexandrou, S. M. Hariprasad, A. Mazzulla, W. F. Mieler; Nasal Bacteria as a Source of Contamination During Intraocular Surgery. Invest. Ophthalmol. Vis. Sci. 2007;48(13):749.
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It is well established that nasal carriage of gram positive organisms is a risk factor for surgical site infections. The use of Mupirocin nasal ointment for preoperative eradication of nasal bacterial carriage resulted in the reduction of conjunctival bacterial flora in one study. The purpose of this study was to demonstrate that nasal bacterial flora may serve as a source of contamination during intraocular surgery, and that Mupirocin ointment applied intranasally may reduce that risk.
In this prospective, blinded clinical trial, 32 patients undergoing intraocular surgery were randomized to either control or study groups. Patients in the study group received pre-operative Mupirocin ointment applied to each nostril for 5 days prior to surgery. Nasal cultures were obtained in all patients (before and after treatment with Mupirocin ointment in the study group). Conjunctival cultures were obtained in all patients at the time of surgery.
All 22 nasal swabs in the control group were positive for bacterial growth, with a total of 46 organisms (medium to heavy colonies of S. Aureus, Coag. Neg. Staph., Corynebacterium, Strep. Viridans) isolated. All 10 nasal swabs in the study group (prior to treatment with Mupirocin ointment) were positive for bacterial growth, with a total of 23 organisms (medium to heavy colonies of S. Aureus, Coag. Neg. Staph., Strep. Viridans, Corynebacterium, NH) isolated. After treatment with Mupirocin ointment, 4 out of 10 nasal samples remained positive, with 4 organisms isolated (rare colony of Coag Neg. Staph in each positive sample). Nine of 22 eyes (41%) in the control group had postive conjunctival cultures, compared with 1 of 10 (10%) in the study group. Each positive conjunctival culture was associated with the same species in the nasal culture of the same patient.
Nasal secretions may contaminate the operative field during intraocular surgery, either by breaching the sterile drape, or via reflux through the nasolacrimal duct system. Further studies are underway to demonstrate how nasal bacteria contaminate the operative field during intraocular surgery. In our study, Mupirocin ointment resulted in the reduction of nasal bacterial flora as well as conjunctival flora, and may reduce the risk of contamination of the operative field from nasal bacteria during intraocular surgery.
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