Alfano Gaetano, Pittiglio Michele, Ferri Camilla, Romaniello Roberta, Oliviero Giuseppe, Cancelli Ylenia, Melara Laura, Tonelli Laura, Montani Martina, Raimondo Davide, Morisi Niccolò, Ligabue Giulia, Giovanella Silvia, Fontana Francesco, Magistroni Riccardo, Donati Gabriele
Nephrology Dialysis and Kidney Transplant Unit, Azienda Ospedaliero - Universitaria di Modena, Via del Pozzo, 71, 41124, Modena, Italy.
Nephrology and Dialysis Unit, Sant'Eugenio di ASL Roma 2, Rome, Italy.
Int Urol Nephrol. 2025 May;57(5):1639-1648. doi: 10.1007/s11255-024-04309-w. Epub 2024 Dec 30.
Screening for nasal carriage of Staphylococcus (S.) aureus is associated with a reduction of peritoneal dialysis (PD)-related infections, but conflicting results have questioned the benefit of this practice. This study evaluated the clinical effectiveness of the screening program for nasal carriage of S. aureus in reducing the peritonitis rate in the PD population.
A single-center retrospective study was conducted on all patients on PD diagnosed with peritonitis from 1999 to 2023. From 2011, screening for S. aureus with nasal swabs was implemented in our program. It was performed before the start of PD and in any case of peritonitis. Consequently, the study period was divided into pre-screening (1999-2010) and screening (2011-2023) phases.
The study included 195 patients who experienced 345 peritonitis episodes. Median age was 67 years. The overall peritonitis rate was 0.21 episodes/patient-year. Post-screening, the S. aureus peritonitis rate decreased significantly from 0.036 to 0.009 episodes/patient-year (P < 0.001). The screening did not reduce the total episodes of peritonitis (0.23 vs. 0.19 episodes/patient-year). Indeed, the cumulative peritonitis rate difference between the two phases was not significant (P = 0.31). The screening of previously decolonized patients with S. aureus peritonitis showed that 50% of them were colonized by S. aureus and that recolonization frequently occured in this population. Multivariate regression analysis showed that S. aureus screening was the only protective measure to reduce the risk of S. aureus peritonitis (OR, 0.36; CI 0.14-0.91; P = 0.03).
In our center, screening for nasal carriage of S. aureus significantly reduced the incidence of S. aureus peritonitis but did not impact the overall peritonitis rate. Recolonization is a real event that warrants a better preventive strategy.
筛查金黄色葡萄球菌鼻腔携带情况与降低腹膜透析（PD）相关感染有关，但相互矛盾的结果对这种做法的益处提出了质疑。本研究评估了金黄色葡萄球菌鼻腔携带筛查项目在降低PD人群腹膜炎发生率方面的临床效果。
对1999年至2023年期间所有诊断为腹膜炎的PD患者进行了一项单中心回顾性研究。从2011年起，我们的项目开始采用鼻拭子筛查金黄色葡萄球菌。在开始PD治疗前以及任何腹膜炎病例中均进行筛查。因此，研究期分为筛查前（1999 - 2010年）和筛查（2011 - 2023年）阶段。
该研究纳入了195例经历345次腹膜炎发作的患者。中位年龄为67岁。总体腹膜炎发生率为0.21次发作/患者年。筛查后，金黄色葡萄球菌腹膜炎发生率从0.036次发作/患者年显著降至0.009次发作/患者年（P < 0.001）。筛查并未降低腹膜炎的总发作次数（0.23次发作/患者年对0.19次发作/患者年）。实际上，两个阶段之间的累积腹膜炎发生率差异不显著（P = 0.31）。对先前已清除金黄色葡萄球菌定植的金黄色葡萄球菌腹膜炎患者进行筛查发现，其中50%的患者再次被金黄色葡萄球菌定植，且该人群中再次定植情况频繁发生。多变量回归分析表明，金黄色葡萄球菌筛查是降低金黄色葡萄球菌腹膜炎风险的唯一保护措施（OR，0.36；CI 0.14 - 0.91；P = 0.03）。
在我们中心，筛查金黄色葡萄球菌鼻腔携带情况显著降低了金黄色葡萄球菌腹膜炎的发生率，但并未影响总体腹膜炎发生率。再次定植是一个实际存在的问题，需要更好的预防策略。
