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The preventive effects of mupirocin against nasotracheal intubation-related bacterial carriage
Satoshi Takahashi1, Kouichiro Minami, Midori Ogawa
1Department of Oral and Maxillofacial Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Unlabelled:
Nasotracheal intubation is often required during dental and maxillofacial surgery. The complications of nasotracheal intubation are well documented, but there have been few systematic attempts to find methods for their prevention. We examined intubation-related carriage of bacteria, especially methicillin-resistant Staphylococcus aureus (MRSA), into the trachea and evaluated the effects of topical nasal treatment with mupirocin on intubation-related bacterial colonization. Of 38 patients without mupirocin treatment (nontreatment group), 27 (71.1%) showed general bacterial colonization in the nasal cavities before intubation. MRSA was isolated from 13.2% of the patients in this group. However, 10 of 22 patients (45%) treated with mupirocin (treatment group) showed colonization by general bacteria, and 2 (9%) were MRSA carriers before intubation. After nasal intubation, general bacteria and MRSA were isolated from the endotracheal tube tip in 66.2% and 16.7% of these patients in the nontreatment group, respectively. In contrast, general bacteria were isolated from the endotracheal tube tip in 19.2% of these patients after oral intubation, but no MRSA was detected. However, after nasal intubation, general bacteria were isolated from the endotracheal tube tip in 3 of the patients in the treatment group (23.1%), and no MRSA was detected, whereas no bacteria were isolated from oral intubation tubes. These results indicate that bacteria were carried into the trachea at a more frequent rate by nasal intubation as compared with oral intubation, and nasal treatment with mupirocin eliminated the nasal carriage of S. aureus. Topical nasal treatment with mupirocin before nasal intubation is thus suggested to be effective for preventing carriage of bacteria into the trachea.
Implications:
We studied the carriage rate of bacteria into the trachea caused by nasal intubation. The bacterial carriage by nasal intubation was more frequent than that by oral intubation, and intranasal administration of mupirocin eliminated the carriage of S. aureus. These results indicate that topical nasal treatment with mupirocin is effective to prevent carriage of bacteria into the trachea.
Insights
Nasotracheal intubation frequently leads to bacterial contamination of the trachea. Pre-operative nasal mupirocin treatment effectively prevents bacterial carriage during intubation, reducing infection risk.
Area of Science:
- Anesthesiology
- Infectious Disease
- Surgical Procedures
Background:
- Nasotracheal intubation is common in dental and maxillofacial surgery.
- Complications of nasotracheal intubation are known, but prevention strategies are underexplored.
- Bacterial colonization, including methicillin-resistant Staphylococcus aureus (MRSA), is a concern.
Purpose of the Study:
- To investigate intubation-related bacterial carriage into the trachea.
- To evaluate the efficacy of topical nasal mupirocin in preventing bacterial colonization.
Main Methods:
- Compared bacterial colonization rates in nasal cavities and endotracheal tubes between patients undergoing nasotracheal intubation with and without pre-operative mupirocin treatment.
- Also compared nasotracheal intubation with oral intubation in a subset of patients.
Main Results:
- Nasotracheal intubation led to higher rates of bacterial and MRSA carriage into the trachea compared to oral intubation.
- Pre-operative nasal mupirocin treatment significantly reduced nasal bacterial and MRSA colonization.
- Mupirocin treatment also decreased bacterial detection on endotracheal tube tips after nasotracheal intubation.
Conclusions:
- Nasotracheal intubation poses a higher risk for bacterial tracheal carriage than oral intubation.
- Topical nasal mupirocin effectively eliminates Staphylococcus aureus nasal carriage.
- Pre-operative nasal mupirocin is a promising strategy to prevent bacterial translocation into the trachea during nasotracheal intubation.
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