Tan N C-W, Drilling A J, Jardeleza C, Wormald P-J
Department of Surgery - Otolaryngology, University of Adelaide, South Australia, Australia.
J Laryngol Otol. 2014 Jan;128 Suppl 1:S28-33. doi: 10.1017/S0022215113001229. Epub 2013 May 31.
Intranasal steroids are the first line of treatment for chronic rhinosinusitis. Although contamination of adjunctive devices (e.g. irrigation bottles) has been much investigated, little is known about nasal contamination of the metered-dose spray bottles used to deliver intranasal steroids, and the potential influence on disease chronicity.
Twenty-five prospectively recruited patients with stable chronic rhinosinusitis underwent microbiological analysis of their nasal vestibule and middle meatus and also of their steroid bottle tip and contents. Additionally, bottle tips were inoculated in vitro with Staphylococcus aureus and various sterilisation techniques tested.
For 18 of the 25 (72 per cent) patients, both nasal and bottle tip swabs grew either Staphylococcus aureus or coagulase-negative staphylococci. Staphylococcus aureus was cultured from 7 of the 25 (28 per cent) patients, and 5 of these 7 had concomitant bacterial growth from both nose and steroid bottle. Thus, the cross-contamination rate was 71 per cent for Staphylococcus aureus infected patients and 20 per cent overall. Sterilisation was effective with boiling water, ethanol wipes and microwaving, but not with cold water or dishwashing liquid.
Nasal steroid spray bottle tips can become contaminated with sinonasal cavity bacteria. Simple sterilisation methods can eliminate this contamination. Patient education on this matter should be emphasised.
鼻内用类固醇是慢性鼻-鼻窦炎的一线治疗药物。尽管辅助装置（如冲洗瓶）的污染已得到大量研究，但对于用于递送鼻内用类固醇的定量喷雾瓶的鼻腔污染情况及其对疾病慢性化的潜在影响却知之甚少。
对25例前瞻性招募的稳定期慢性鼻-鼻窦炎患者的鼻前庭、中鼻道以及类固醇喷雾瓶的瓶头和内容物进行微生物学分析。此外，将瓶头在体外接种金黄色葡萄球菌并测试各种灭菌技术。
25例患者中有18例（72%）的鼻腔和瓶头拭子培养出金黄色葡萄球菌或凝固酶阴性葡萄球菌。25例患者中有7例（28%）培养出金黄色葡萄球菌，这7例中的5例鼻腔和类固醇喷雾瓶均有细菌生长。因此，金黄色葡萄球菌感染患者的交叉污染率为71%，总体交叉污染率为20%。沸水、乙醇擦拭和微波消毒有效，但冷水或洗洁精消毒无效。
鼻用类固醇喷雾瓶头可被鼻窦腔细菌污染。简单的消毒方法可消除这种污染。应强调对此问题对患者进行教育。
