title: Role of topical antibiotic prophylaxis in prevention of bacterial translocation into upper trachea in nasally intubated patients undergoing tonsillectomies.
abstract: BACKGROUND
  The human oropharynx and nasopharynx are home of different bacteria and fungi. The initial sterile endotracheal tube (ETT) transfers mechanically the bacteria from the nasopharynx and oropharynx to the sterile tracheobronchial tree. We investigated the efficacy of Neomycin-Bacitracin combination spray in the prevention of this bacterial translocation through its application over and inside the lumen of the endotracheal tubes preoperatively.
  
  
  METHODS
  Ninety patients aged (from 8 to 15 years) with ASA I and II were randomly assigned into 2 groups (45 patients for each): Group I; patients with naso-tracheal intubation which sprayed by placebo spray (Lidocaine) and group II; with naso-tracheal intubation that sprayed with antibiotic spray (combined Neomycin sulphate and Bacitracin) on the outside wall of the tube and inside its lumen. At the end of surgery and immediately after extubation, swabs were taken from the upper trachea using cotton tipped swab for bacterial growth. Inflammatory biomarkers were assessed preoperatively and postoperatively to detect any laboratory differences between both groups.
  
  
  RESULTS
  In the control group, all patients had heavy bacterial contamination and they were at either level 3 or 4 colony forming units. Thirty-two patients (71%) were at level 3 while 13 patients (29%) were at level 4. In the study group, there were 28 (62.2%) patients showed no bacterial growth, 15 (33.3%) patients were level 1, and 2 patients (4.4%) at level 2 colony forming units. There were no clinical differences between the 2 groups. Also, there was no significant difference between the 2 groups regarding to their postoperative body temperature although the inflammatory biomarkers were significantly higher in the control group.
  
  
  CONCLUSIONS
  Bacterial translocation by endotracheal intubation to the tracheobronchial tree could be prevented by local antibiotic spray application to outer and inner walls of the endotracheal tubes.
authors.affiliation: Department of Otolaryngology, Faculty of Medicine, Mansoura University Hospital, Egypt. mabusamra69@yahoo.com
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abu Samra
authors.forename: Hanaa
authors.initials: H
authors.lastname: El Bendary
authors.forename: Salwa M S
authors.initials: SM
authors.lastname: Hayes
authors.forename: Mona B
authors.initials: MB
authors.lastname: Elhadidy
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001414:Bacitracin / Q000008:administration & dosage / Q000627:therapeutic use*; D018988:Bacterial Translocation / Q000187:drug effects*; D002648:Child; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D009355:Neomycin / Q000008:administration & dosage / Q000627:therapeutic use*; D014068:Tonsillectomy / Q000009:adverse effects*; D014132:Trachea / Q000382:microbiology*
chemical_list: D001414:Bacitracin; D009355:Neomycin