Crabtree J H, Hadnott L L, Burchette R J, Siddiqi R A
Department of Surgery, Kaiser Permanente Bellflower Medical Center, California, USA.
Adv Perit Dial. 2000;16:271-5.
Staphylococcus aureus nasal carriage (SANC) is a risk factor for development of S. aureus dialysis-related infections. Reported here are results of a SANC surveillance and treatment program employed by our dialysis unit over a two-year period. Surveillance nasal cultures were performed at 3-month intervals in 129 peritoneal dialysis patients. Those with SANC applied mupirocin ointment intranasally 3 times daily for 5 consecutive days for 3 consecutive months. Treatment was repeated only when subsequent cultures showed SANC. Infection and catheter loss rates were compared to 63 historical controls, and between SANC and non SANC patients of the study group. Patients who were initially non carriers showed increasing probability for acquiring SANC throughout the study period. Following treatment, the probability for recurrence of SANC was 26%, 41%, 58%, and 62% at 1, 3, 6, and 12 months. The rates of S. aureus exit-site or tunnel infection (p = 0.36), peritonitis (p = 0.0002), and catheter loss (p = 0.01) were lower in the study group as compared to controls. Despite treatment, SANC patients demonstrated a twofold increase in exit-site/tunnel infection rate (p = 0.03) and a threefold increase in catheter loss rate (p = 0.1) as compared to non SANC patients. The high rate of SANC recurrence and the long interval between surveillance cultures may explain the failure of the current protocol to completely eliminate the risk for S. aureus infections. The results support a change in the treatment plan to that of continuing the monthly mupirocin regimen indefinitely once SANC has been identified.
金黄色葡萄球菌鼻腔携带（SANC）是发生金黄色葡萄球菌透析相关感染的一个危险因素。本文报告了我们透析单元在两年期间实施的一项SANC监测与治疗计划的结果。对129例腹膜透析患者每隔3个月进行一次鼻腔监测培养。SANC患者每天3次鼻内应用莫匹罗星软膏，连续5天，共连续3个月。仅在后续培养显示为SANC时才重复治疗。将感染和导管丢失率与63例历史对照进行比较，并在研究组的SANC和非SANC患者之间进行比较。最初非携带者的患者在整个研究期间获得SANC的可能性增加。治疗后，SANC复发的概率在1、3、6和12个月时分别为26%、41%、58%和62%。与对照组相比，研究组金黄色葡萄球菌出口部位或隧道感染率（p = 0.36）、腹膜炎（p = 0.0002）和导管丢失率（p = 0.01）较低。尽管进行了治疗，但与非SANC患者相比，SANC患者的出口部位/隧道感染率增加了两倍（p = 0.03），导管丢失率增加了三倍（p = 0.1）。SANC复发率高以及监测培养之间的间隔时间长，可能解释了当前方案未能完全消除金黄色葡萄球菌感染风险的原因。结果支持将治疗计划改为一旦确定为SANC就无限期继续每月使用莫匹罗星方案。
