Nasal Vestibulitis & Staphylococcus aureus Nasal Colonization

Key Features

• Vestibulitis: 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

• S aureus is the leading nosocomial pathogen in the world, 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

Clinical Findings & Diagnosis

• While most patients have no vestibulitis symptoms, screening methods (including nasal swabs and polymerase chain reaction (PCR)-based assays) have demonstrated rates of S aureus nasal colonization at around 30% and methicillin-resistant S aureus colonization in patients in the intensive care unit to be as high as 11%

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

Treatment

• Vestibulitis

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

  • Topical mupirocin (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