THE NOSE - AN UNDERESTIMATED SOURCE OF STAPHYLOCOCCUS-AUREUS CAUSING WOUND-INFECTION

For the last fifty years, the nose has been intermittently recognized and targeted as a source of Staphylococcus aureus causing surgical sit e infection. In London in 1959, Williams and co-workers established fo r the first time that nasal carriers had increased rates of surgical s epsis compared with non-carriers. For half of these patients, the sour ce was the patient's own nose. Post-admission acquisition of tetracycl ine-resistant strains was associated with even higher rates of infecti on. The increasing appearance of epidemic methicillin-resistant S. aur eus (MRSA) in the 1980s rekindled interest in these (largely overlooke d) studies, when the elimination of nasal carriage by topical mupiroci n proved pivotal for the control of MRSA in Northern Europe and elsewh ere. In the late 1980s and 1990s, Boelaert, Holton and others, appreci ating the work performed forty years previously, used nasal mupirocin for the successful prevention of sepsis with S. aureus in patients on haemodialysis and continuous ambulatory peritoneal dialysis without in curring problems with mupirocin resistance. In 1995, Kluytmans and col leagues demonstrated that nasal carriage of S. aureus is a significant risk factor for wound infection after cardiac surgery. Towards the ye ar 2000, the use of prophylactic nasal mupirocin for the prevention of serious sepsis in major clean surgery is emerging as a plausible and exciting new strategy.