Reduction of Pre-Operative Conjunctival Bacterial Flora With the Use of Mupirocin Nasal Ointment

Abstract

Purpose:: UIt is well established that nasal carriage of gram positive organisms is a risk factor for surgical site infections. Multiple studies have shown that nasal application of Mupirocin ointment reduces the rate of nasal gram positive organism carriage, which in turn has been shown to reduce the incidence of postoperative infections in cardiothoracic, orthopedic, and other surgical patients. The purpose of this study was to determine whether the use of Mupirocin ointment for preoperative eradication of nasal bacterial carriage was effective in reducing conjunctival bacterial flora.

Methods:: In this prospective, blinded clinical trial, 42 eyes 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 (study group cultures were obtained prior to administration of Mupirocin). All patients received a standard 5% povidone-iodine prep before the surgical procedure, and conjunctival cultures were obtained in all patients before and after the povidone-iodine prep.

Results:: All 42 patient nasal swabs were positive for bacterial growth. Two of 20 eyes (10%) in the study group had positive conjunctival cultures prior to povidone-iodine prep, compared with 9 of 22 eyes (41%) in the control group (p< 0.05). Even after the povidone-iodine prep, 8 of 22 eyes (36%) in the control group demonstrated persistent positive cultures (p< 0.05), while 1 (5%) of the study eyes exhibited growth.

Conclusions:: Prophylactic use of Mupirocin nasal ointment resulted in significant reduction of conjunctival flora-with or without preoperative topical 5% povidone-iodine prep. The use of Mupirocin nasal ointment prior to intraocular surgery or intravitreal injections is a novel method for reducing conjunctival contamination rates, which in turn should reduce the incidence of post-operative endophthalmitis.

Clinical Trial:: www.clinicaltrials.gov Registration submitted and Pending.

Keywords: endophthalmitis • conjunctiva • bacterial disease