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Abstract
Infections with organisms resistant to conventional antibiotics are of increasing concern. This observational study investigates the bacterial colonization of the peristomal area of laryngectomy patients.
Thirty-two consecutive patients who had previously undergone laryngectomy were recruited from the Head and Neck Clinic of a teaching hospital. Swabs were taken from the laryngectomy stoma site, the mouth and both nasal cavities. Microbiological culture and isolation were performed following standard procedures.
Despite no clinical sign of infection, 27 patients were found to be carriers of one or more organism (84.4 per cent). Staphylococcus aureus was detected in the peristomal area of 15 patients (46.9 per cent). Methicillin-resistant Staphylococcus aureus (MRSA) was isolated in seven (21.9 per cent) cases.
In this series the authors found a high incidence of colonization with potentially pathogenic bacteria in laryngectomy stomas with no clinical signs of infection. In a significant number of patients, Gram positive organisms were identified that could potentially cause cellulitis or wound infections.
Key words: Bacterial Colonization; Laryngectomy; Staphylococcus aureus; Methicillin Resistance
Introduction
Nosocomial infections are a significant problem in the post-operative care of patients undergoing major surgery. Usually such infections occur in the early post-operative phase and the role of antibiotic chemoprophylaxis has been debated.1 In laryngectomy patients it is less usual to have peristomal infections in the absence of recurrent disease. Two patients presented to this department with peristomal cellulitis 10 and 19 months after they underwent laryngectomy. Both cases were caused by MRSA and were treated successfully with vancomycin. As a result of these cases it was decided to investigate the peristomal colonization in laryngectomy patients and to identify the organisms present.
Methods
Thirty-two consecutive patients having previously undergone laryngectomy were recruited from the Head and Neck Clinic. Patients were seen during their routine appointment in the Head and Neck Clinic and informed consent was obtained for this study. In addition to patient details, the following information was recorded: date of laryngectomy, previous radiotherapy, admission to hospital within the preceding six months, previous MRSA status (if known), presence or absence of tracheo-oesophageal fistula and type of speaking valve, if present. Swabs were taken from the laryngectomy peristomal site, both nasal cavities and the mouth after examination of these sites to rule out active infection. Microbiological...