Amato D, Miranda G, Leaños B, Alcántara G, Hurtado M E, Paniagua R
Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av Cuauhtémoc 330, Colonia Doctores, Mexico City 06725, Mexico.
Am J Kidney Dis. 2001 Jan;37(1):43-48. doi: 10.1053/ajkd.2001.20576.
To evaluate the relationship of nasal or skin Staphylococcus carrier status with identical strains and the development of staphylococcal peritonitis, 59 consecutive peritonitis episodes in patients using a twin-bag system for continuous ambulatory peritoneal dialysis from a single dialysis center were prospectively studied. Dialysate samples and exit-site, nose, and nail swabs from patients and their dialysis partners were obtained on the same day for culture. When bacteria belonging to the same species of the Staphylococcus genus were isolated from dialysate and at least one extraperitoneal anatomic site, pulsed-field gel electrophoresis typing was performed. The bacterial strains isolated from catheter exit site, nose, or nails of each patient and his or her dialysis partner were classified as identical or different. Twenty-seven of the 59 peritonitis episodes (46%) were caused by staphylococci. Nineteen of these 27 patients carried the same Staphylococcus species causing the peritonitis episode at the exit site, nose, or nails, but only 17 patients (63%) carried an identical strain. Four of 5 dialysis partners carried the same Staphylococcus species causing the peritonitis episode at nose or nails, but the strain was identical for only 3 dialysis partners (60%). Four patients and 1 dialysis partner carried unrelated strains of the Staphylococcus species causing the peritonitis episode. The most frequently colonized site with strains identical to that causing the peritonitis episode was the catheter exit site, followed by nose and nails. This finding may be clinically relevant because eradication of Staphylococcus aureus colonizing the catheter exit site may be more important and have a greater likelihood of success than maneuvers directed to more distant locations.
为评估鼻腔或皮肤金黄色葡萄球菌携带状态与相同菌株及葡萄球菌性腹膜炎发生之间的关系，我们对来自单个透析中心、使用双联袋系统进行持续性非卧床腹膜透析的患者连续发生的59次腹膜炎发作进行了前瞻性研究。在同一天采集患者及其透析伙伴的透析液样本、出口处、鼻腔和指甲拭子进行培养。当从透析液和至少一个腹膜外解剖部位分离出属于葡萄球菌属同一菌种的细菌时，进行脉冲场凝胶电泳分型。将从每位患者及其透析伙伴的导管出口处、鼻腔或指甲分离出的细菌菌株分类为相同或不同。59次腹膜炎发作中有27次（46%）由葡萄球菌引起。这27例患者中有19例在出口处、鼻腔或指甲携带导致腹膜炎发作的相同葡萄球菌菌种，但只有17例患者（63%）携带相同菌株。5名透析伙伴中有4名在鼻腔或指甲携带导致腹膜炎发作的相同葡萄球菌菌种，但只有3名透析伙伴（60%）的菌株相同。4例患者和1名透析伙伴携带与导致腹膜炎发作无关的葡萄球菌菌株。与导致腹膜炎发作的菌株相同的最常定植部位是导管出口处，其次是鼻腔和指甲。这一发现可能具有临床相关性，因为根除定植于导管出口处的金黄色葡萄球菌可能比针对更远部位的措施更为重要且成功可能性更大。
