Abstract
Purpose: :
It is well established that nasal carriage of gram positiveorganisms is a risk factor for surgical site infections. Mupirocin nasal ointment applied 5 days prior to surgery for the preoperative eradication of nasal bacterial carriage resulted in the reduction of conjunctival bacterial flora in our previously reported work. The purpose of this study was to determine whether 3 days of treatment with Mupirocin nasal ointment would be as effective as 5 days of treatment in the preoperative eradication of nasal bacterial carriage and reduction of conjunctival bacterial flora.
Methods: :
In this prospective, blinded clinical trial, 42 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 either 5 days or 3 days prior to surgery. Nasal cultures were obtained in all patients (before and after treatment with Mupirocin ointment in the study groups). Conjunctival cultures were obtained in all patients at the time of surgery.
Results: :
All 22 nasal swabs in the control group were positive for bacterial growth, with a total of 46 organisms isolated. Prior to treatment with Mupirocin nasal ointment, all 11 nasal swabs in the 5 day study group (25 organisms isolated) were positive for bacterial growth, as well as all 9 nasal swabs (21 organisms) in the 3 day study group. Medium to heavy colonies of S. Aureus, Coag. Neg. Staph., Strep. Viridans,Corynebacterium, NH were isolated in all 3 groups. After treatment with Mupirocin ointment, 4 out of 11 nasal samples remained positive in the 5 day study group, compared to 2 out of 9 positive samples in the 3 day study group (rare colony of Coag Neg. Staph in each positive sample). Nine of 22 eyes (41%) in the control group had positive conjunctival cultures at the time of surgery, compared with 1 of 11 (10%) in the 5 day study group, and 1 of 9 (11%) in the 3 day study group.
Conclusions: :
Prophylactic use of Mupirocin nasal ointment for 5 daysprior to surgery resulted in the reduction of nasal and conjunctival flora(with or without pre-operative 5% povidone-iodine prep) in our previously reported work. We demonstrate a similar reduction of nasal and conjunctival flora with the administration of Mupirocin nasal ointment for 3 days prior to intraocular surgery. The use of Mupirocin nasal ointment prior to intraocular surgery is a novel method for reducing conjunctival contamination rates, and the shorter duration of use with 3 days may result in increased patient compliance, as well as lower costs.
Clinical Trial: :
www.clinicaltrials.gov NCT00406913
Keywords: endophthalmitis • conjunctiva • microbial pathogenesis: clinical studies