Solares C Arturo, Batra Pete S, Hall Geraldine S, Citardi Martin J
The Cleveland Clinic Foundation, Head and Neck Institute, OH 44195, USA.
Am J Otolaryngol. 2006 May-Jun;27(3):161-5. doi: 10.1016/j.amjoto.2005.09.006.
Chronic rhinosinusitis (CRS) exacerbations due to methicillin-resistant Staphylococcus aureus (MRSA) are routinely encountered. Treatment often involves intravenous antibiotics that provide only transient benefits. Mupirocin has well-recognized antistaphylococcal activity, and its nasal formulation is approved by the Food and Drug Administration for the eradication of nasal colonization with MRSA.
The aim of this study was to describe the use of mupirocin nasal irrigations for the treatment of CRS exacerbations due to MRSA.
Charts of patients who received mupirocin nasal irrigations for MRSA exacerbations of CRS between January 2000 and October 2003 were reviewed.
Forty-two MRSA-positive cultures were obtained from 24 patients (mean age, 61 years; range, 38-82 years; 15 women and 6 men). Twenty-eight episodes were treated with mupirocin nasal irrigations and doxycycline; 4 were treated with mupirocin nasal irrigations and trimethoprim-sulfamethoxazole, and 7 episodes were treated with mupirocin nasal irrigations alone. Patients were reevaluated at approximately 4 to 6 weeks. Repeat cultures were not obtained in 12 patients (because of clinical and endoscopic resolution). Adequate follow-up was unavailable for 3 patients, and of the 27 repeat cultures, only 1 grew MRSA. Twelve patients had at least one recurrence, with a mean number of episodes of 1.75 (range, 1-8 episodes). The mean follow-up was 11.8 months (range, 3-27 months).
Mupirocin nasal irrigations may avoid the need for intravenous antibiotics, which often provide temporary benefits and entail greater cost and morbidity. Thus, mupirocin nasal irrigations may provide a relatively simple means for the management of MRSA exacerbations of CRS.
耐甲氧西林金黄色葡萄球菌(MRSA)引起的慢性鼻-鼻窦炎(CRS)急性发作很常见。治疗通常需要静脉使用抗生素,但只能带来短暂的益处。莫匹罗星具有公认的抗葡萄球菌活性,其鼻用制剂已获美国食品药品监督管理局批准用于根除鼻腔内的MRSA定植。
本研究旨在描述莫匹罗星鼻腔冲洗治疗MRSA引起的CRS急性发作的应用情况。
回顾了2000年1月至2003年10月期间因CRS的MRSA急性发作而接受莫匹罗星鼻腔冲洗的患者病历。
从24例患者(平均年龄61岁;范围38 - 82岁;15名女性和6名男性)中获得了42份MRSA阳性培养物。28次发作采用莫匹罗星鼻腔冲洗联合强力霉素治疗;4次发作采用莫匹罗星鼻腔冲洗联合甲氧苄啶-磺胺甲恶唑治疗,7次发作仅采用莫匹罗星鼻腔冲洗治疗。患者在大约4至6周时接受重新评估。12例患者未进行重复培养(因为临床和内镜检查显示病情缓解)。3例患者未获得充分随访,在27次重复培养中,仅1次培养出MRSA。12例患者至少有一次复发,平均发作次数为1.75次(范围1 - 8次)。平均随访时间为11.8个月(范围3 - 27个月)。
莫匹罗星鼻腔冲洗可能避免使用静脉抗生素,静脉抗生素通常只能带来暂时益处,且成本更高、发病率更高。因此,莫匹罗星鼻腔冲洗可能为管理CRS的MRSA急性发作提供一种相对简单的方法。