++
++
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
++
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