Mehmet BOĞA, Muharrem İsmail BADAK, Uğur GÜRCÜN, Şenol GÜLMEN, Berent DİŞCİGİL, Erdem Ali ÖZKISACIK

Açık kalp cerrahisinde profilaktik nazal mupirosin uygulaması

Amaç: Açık kalp cerrahisinde Staphylococcus aureus’a bağlı nazal enfeksiyonları önlemek için profilaktik olarak mupirosin kullanıldı bunun sternal enfeksiyonu önlemedeki etkisi araştırıldı. Çalışma planı: Elektif açık kalp cerrahisi geçiren ardışık 250 hasta (188 erkek, 62 kadın; ort. yaş 58.8±13.1; dağılım 13-90) çalışmaya alındı. Hastalara yatıştan itibaren ameliyat gününe kadar her iki burun deliğine günde iki kez topikal mupirosin uygulandı. Ameliyat öncesinde nazal mupirosin kullanım süresi ortalama 5.7±2.6 gündü. Mupirosin uygulamasından önce ve ameliyattan sonra ikinci günde burun kültürleri alındı.Bulgular: Ameliyat öncesi alınan nazal kültürlerde 226 hastada (%89.6) normal flora, 25 hastada (%10) stafilokok, bir hastada (%0.4) Klebsiella pneumoniae üredi. Ameliyat sonrası alınan nazal kültürlerde ise daha önce nazal flora üreyen bir hastada stafilokok üredi (%0.4). Daha önce stafilokok üremiş iki hastada (%0.8) tekrar stafilokok üredi. Mupirosin kullanımına bağlı yan etki görülmedi ve ameliyat sonrası S. aureus ile ilgili yara yeri enfeksiyonu gelişmedi.Sonuç: Bulgularımız, mupirosin kullanımının nazal S. aureus eradikasyonunda etkili ve güvenli olduğunu göstermektedir.

Prophylactic nasal mupirocin application in open heart surgery

Background: We applied prophylactic mupirocin during open heart surgery to eradicate nasal infections caused by Staphylococcus aureus and investigated its effect on the prevention of sternal infections. Methods: The study included 250 consecutive patients (188 males, 62 females; mean age 58.8±13.1 years; range 13 to 90 years) who underwent elective cardiac surgery. Intranasal topical mupirocin was applied to both nasal cavities twice daily from admission to the operation day. The mean length of preoperative nasal mupirocin application was 5.7±2.6 days. Nasal cultures were taken before mupirocin administration and on the second postoperative day.Results: Preoperatively, normal flora was found in 226 patients (89.6%), S. aureus in 25 patients (10%), and Klebsiella pneumoniae in one patient (0.4%). S. aureus was isolated in one patient who had normal nasal flora preoperatively. Eradication was found unsuccessful in two patients (0.8%) with positive preoperative nasal cultures. No complications were encountered associated with mupirocin use and no S. aureus-related wound site infections were observed.Conclusion: Nasal mupirocin application was found to be effective and safe in the eradication of nasal staphylococcus infections.

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