Re: Update--sinus infection

[Guest guest]

,

This contamination is unfortunate ; you could irrigate with mupirocin to make

sure it reaches the germ ; a spray will not reach the far areas of your sinuses.

Can your doctor give you more mupirocin either as aqueous solution or as gel to

dissolve yourself ? Some staph may become resistant to it, but maybe yours are

not that resistant yet.

----------------

J Antimicrob Chemother. 2009 Jul;64(1):9-15. Epub 2009 May 18.

Nasal decolonization of Staphylococcus aureus with mupirocin: strengths,

weaknesses and future prospects.

Coates T, Bax R, Coates A.

University College London, London, UK. acoates@...

Staphylococcus aureus in the nose is a risk factor for endogenous staphylococcal

infection. UK guidelines recommend the use of mupirocin for nasal decolonization

in certain groups of patients colonized with methicillin-resistant S. aureus

(MRSA). Mupirocin is effective at removing S. aureus from the nose over a few

weeks, but relapses are common within several months.

There are only a few prospective randomized clinical trials that have been

completed with sufficient patients, but those that have been reported suggest

that clearance of S. aureus from the nose is beneficial in some patient groups

for the reduction in the incidence of nosocomial infections. There is no

convincing evidence that mupirocin treatment reduces the incidence of surgical

site infection. New antibiotics are needed to decolonize the nose because

bacterial resistance to mupirocin is rising, and so it will become less

effective. Furthermore, a more bactericidal antibiotic than mupirocin is needed,

on the grounds that it might reduce the relapse rate, and so clear the patient

of MRSA for a longer period of time than mupirocin.

----------------

N Engl J Med. 2010 Jan 7;362(1):9-17.

Preventing surgical-site infections in nasal carriers of Staphylococcus aureus.

Bode LG, Kluytmans JA, Wertheim HF, Bogaers D, Vandenbroucke-Grauls CM,

Roosendaal R, Troelstra A, Box AT, Voss A, van der Tweel I, van Belkum A,

Verbrugh HA, Vos MC.

Department of Medical Microbiology and Infectious Diseases, Erasmus University

Medical Center, Rotterdam, The Netherlands. l.bode@...

Comment in:

N Engl J Med. 2010 Jan 7;362(1):75-7.

BACKGROUND: Nasal carriers of Staphylococcus aureus are at increased risk for

health care-associated infections with this organism. Decolonization of nasal

and extranasal sites on hospital admission may reduce this risk. METHODS: In a

randomized, double-blind, placebo-controlled, multicenter trial, we assessed

whether rapid identification of S. aureus nasal carriers by means of a real-time

polymerase-chain-reaction (PCR) assay, followed by treatment with mupirocin

nasal ointment and chlorhexidine soap, reduces the risk of hospital-associated

S. aureus infection.

RESULTS: From October 2005 through June 2007, a total of 6771 patients were

screened on admission. A total of 1270 nasal swabs from 1251 patients were

positive for S. aureus. We enrolled 917 of these patients in the

intention-to-treat analysis, of whom 808 (88.1%) underwent a surgical procedure.

All the S. aureus strains identified on PCR assay were susceptible to

methicillin and mupirocin. The rate of S. aureus infection was 3.4% (17 of 504

patients) in the mupirocin-chlorhexidine group, as compared with 7.7% (32 of 413

patients) in the placebo group (relative risk of infection, 0.42; 95% confidence

interval [CI], 0.23 to 0.75). The effect of mupirocin-chlorhexidine treatment

was most pronounced for deep surgical-site infections (relative risk, 0.21; 95%

CI, 0.07 to 0.62). There was no significant difference in all-cause in-hospital

mortality between the two groups. The time to the onset of nosocomial infection

was shorter in the placebo group than in the mupirocin-chlorhexidine group

(P=0.005).

CONCLUSIONS: The number of surgical-site S. aureus infections acquired in the

hospital can be reduced by rapid screening and decolonizing of nasal carriers of

S. aureus on admission. (Current Controlled Trials number, ISRCTN56186788.) 2010

Massachusetts Medical Society

>

> The new cultures came back with S. aureus. Great! Any recommendations? My ENT

has me on the mupirocin spray, an antibiotic, but since this call I am to start

Avelox and Keflex tomorrow.

>

[Guest guest]

I still have a partial tube left. I thought about doing it last night, but with

your recommendation, I will probably try it tonight. How much of the mupirocin

cream do you think I should add to my rinse? I actually feel grand: I'm back to

my normal (i.e. strenuous) exercise schedule and sleeping through the night, but

I don't want this to get worse!

I love how nothing cultured out at the time of surgery, but now I have staph. A

bonus, I guess.

> >

> > The new cultures came back with S. aureus. Great! Any recommendations? My

ENT has me on the mupirocin spray, an antibiotic, but since this call I am to

start Avelox and Keflex tomorrow.

> >

>

[Guest guest]

Becca,

Dr. Bouvier has me mix the mupirocin into saline mist as well. She has me use

it as an infection preventative since I get irritation from Colorado's dry air.

I use it a few times a day if I notice any blood or small bits of yellow

discharge in my rinse.

Avelox is the antibiotic they always use for me now as I have several antibiotic

allergies. Avelox works really well for me with minimal side effects. One

thing to note though, (especially with your " strenuous " exercise routine) is the

increased risk of tendon rupture with quinilone antibiotics (such as Avelox).

You may want to ask about whether you should modify your routine while you are

on it or for a while following it.

Good luck! Bummer to get the staph so soon after your surgery. Hope it

resolves quickly.

Jennie

> > >

> > > The new cultures came back with S. aureus. Great! Any recommendations? My

ENT has me on the mupirocin spray, an antibiotic, but since this call I am to

start Avelox and Keflex tomorrow.

> > >

> >

>

[Guest guest]

is right, preferably no tendon exercise -at all- while on quinolones.

Reducing exercise will also alleviate airflow strain on the healing mucosa.

Regarding the mupirocin, there is a potential risk of resistance if used

permanently, but every once in a while should be ok. Mist nebulization with a

nebulizer is excellent but irrigating is fine too if all sinuses are accessible

(except for the frontals, if they are not concerned). You can also combine both.

Regarding the dosage, adjust the quantity so that the same amount of active

principle gets delivered as in the spray dosage. Antibiotics pre-op and for a

few weeks post-op, at least 2 weeks, should be the norm ; a freshly operated

mucosa cannot fight off germs by itself - it's a pity surgeons don't think about

it systematically as a best practice. A post-op mucosa is like fine china -

fragile. Hang on, get this staph off your mucosa, and you will be back on track.

> > > >

> > > > The new cultures came back with S. aureus. Great! Any recommendations?

My ENT has me on the mupirocin spray, an antibiotic, but since this call I am to

start Avelox and Keflex tomorrow.

> > > >

> > >

> >

>

[Guest guest]

According to Dr Scadding, a leading ENT/Samters specialist here in the UK, you should add about 1/2" - say 1cm to a Neilmed bottle as a rinse solution. I have had MRSA colonisation for about 2 years always picked up on the nasal swabs and not the groin ones. More recently I changed my GP and she has taken on getting me cleared and after about 6 weeks of 3 different oral antibiotics in succesive treatments I got clear swabs in the early New Year. On seeing Dr Scadding, where I was hoping she would undertake desense, she said I should defer that as I am awaiting a hernia operation. In the meantime I was prescribed mupirocin cream (bactroban) to use if my gunge appeared to get green/yellow coloured. Suprise surpise it has happened over this last week.

I found that heating the water mix in the Neilmed for about 50 secs on high in my 800watt microwave with the cream helped too get it dispersed with a good shake thereafter. Then let it cool for about 5 to 10 mins and away you go! Not that pleasant but we are all used to that are we not?

It certainly seems to be helping - once in morning and once at night. I am just about to prepare this evenings mix.

About 30% of the Uk population are thought to be MRSA colonised so it is difficult to keep away from it. The seats in the metro in London are said to have about everything nasty that is going araound in each square centimetre. I stand!

Best wishes and good luck.

Mike

samters From: rebeebit@...Date: Tue, 23 Feb 2010 15:09:29 +0000Subject: Re: Update--sinus infection

I still have a partial tube left. I thought about doing it last night, but with your recommendation, I will probably try it tonight. How much of the mupirocin cream do you think I should add to my rinse? I actually feel grand: I'm back to my normal (i.e. strenuous) exercise schedule and sleeping through the night, but I don't want this to get worse!I love how nothing cultured out at the time of surgery, but now I have staph. A bonus, I guess.> >> > The new cultures came back with S. aureus. Great! Any recommendations? My ENT has me on the mupirocin spray, an antibiotic, but since this call I am to start Avelox and Keflex tomorrow.> >>

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[Guest guest]

Thanks for the tips, Jennie. You should tell Dr. Bouvier that we " know " each

other through this group: she was amused to find out that I was directed to her

via this group.

Anyhoo, I read about the risk of tendon rupture with Avelox. It seems like a

small risk, but I'll take it easy, thanks for mentioning that. I'm supposed to

start taking Cephelex as well.

I emailed Dr. Bouvier about mupirocin in the nasal rinse, I will let the group

know what she says.

> > > >

> > > > The new cultures came back with S. aureus. Great! Any recommendations?

My ENT has me on the mupirocin spray, an antibiotic, but since this call I am to

start Avelox and Keflex tomorrow.

> > > >

> > >

> >

>

[Guest guest]

Great information, Mike. I assume you meant 1 cc of mupirocin? I'll give it a

whirl tonight, I'm actually getting less and less stuff.

Do some of you also empty an antibiotic capsule into your rinse? I was told by a

friend that works as well.

Becca

> > >

> > > The new cultures came back with S. aureus. Great! Any recommendations? My

ENT has me on the mupirocin spray, an antibiotic, but since this call I am to

start Avelox and Keflex tomorrow.

> > >

> >

>

>

>

>

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>

[Guest guest]

Becca

I meant 1 centimetre being the length of cream as it comes out of the tube. Not 1 cc.

Over this side of the pond that is about 1/2"

You should only use this at intervals and not on a near permanent basis

Good luck

Mike

samters From: rebeebit@...Date: Wed, 24 Feb 2010 14:40:19 +0000Subject: Re: Update--sinus infection

Great information, Mike. I assume you meant 1 cc of mupirocin? I'll give it a whirl tonight, I'm actually getting less and less stuff.Do some of you also empty an antibiotic capsule into your rinse? I was told by a friend that works as well.Becca> > >> > > The new cultures came back with S. aureus. Great! Any recommendations? My ENT has me on the mupirocin spray, an antibiotic, but since this call I am to start Avelox and Keflex tomorrow.> > >> >> > > > > > __________________________________________________________> Got a cool Hotmail story? Tell us now> http://clk.atdmt.com/UKM/go/195013117/direct/01/>

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