title: The preventive effects of mupirocin against nasotracheal intubation-related bacterial carriage.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Kouichiro
authors.initials: K
authors.lastname: Minami
authors.forename: Midori
authors.initials: M
authors.lastname: Ogawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyamoto
authors.forename: Kunio
authors.initials: K
authors.lastname: Ikemura
authors.forename: Akio
authors.initials: A
authors.lastname: Shigematsu
authors.forename: Hatsumi
authors.initials: H
authors.lastname: Taniguchi
mesh_terms: D000281:Administration, Intranasal; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D016106:Methicillin Resistance; D016712:Mupirocin / Q000008:administration & dosage / Q000494:pharmacology*; D009297:Nasal Mucosa / Q000187:drug effects / Q000382:microbiology*; D009824:Ointments; D019647:Oral Surgical Procedures; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development
chemical_list: D000900:Anti-Bacterial Agents; D009824:Ointments; D016712:Mupirocin