Nasal Vestibulitis & S aureus Nasal Colonization

Treatment of Nasal Vestibulitis & S aureus Nasal Colonization

Treatment of Nasal Vestibulitis & S aureus Nasal Colonization

The nose is an important site for Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) colonization in humans, and S. aureus is predominantly located in the anterior nasal vestibule on the septum adjacent to the nasal ostium on the moist squamous epithelium.

Inflammation of the nasal vestibule may result from folliculitis of the hairs that line this orifice and is usually the result of nasal manipulation or hair trimming.

Systemic antibiotics effective against S aureus (such as dicloxacillin, 250 mg orally four times daily for 7–10 days) are indicated.

Topical mupirocin 2% nasal ointment (applied two or three times daily) may be a helpful addition and may prevent future occurrences.

If recurrent, the addition of rifampin (10 mg/kg orally twice daily for the last 4 days of dicloxacillin treatment) may eliminate the S aureus carrier state.

If a furuncle exists, it should be incised and drained, preferably intranasally. Adequate treatment of these infections is important to prevent retrograde spread of infection through valveless veins into the cavernous sinus and intracranial structures.

S aureus is the leading nosocomial pathogen, and nasal carriage is a well-defined risk factor in the development and spread of nosocomial infections. Nasal and extranasal methicillin-resistant S aureus (MRSA) colonization are associated with a 30% risk of developing an invasive MRSA infection during hospital stays. While the vast majority have no vestibulitis symptoms, screening by nasal swabs and PCR-based assays has a demonstrated 30% rate of S aureus colonization in hospital patients and an 11% rate of MRSA colonization in intensive care unit patients.

Elimination of the carrier state is challenging, but studies of mupirocin 2% nasal ointment application with chlorhexidine facial washing (40 mg/mL) twice daily for 5 days have demonstrated decolonization in 39% of patients.

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