Role of Staphylococcus aureus Nasal Carriage in Uremic Pruritus and Infection in Hemodialysis Patients.

BACKGROUND

While Staphylococcus aureus (S. aureus) is a well-recognized concern in hemodialysis (HD) patients, its role in uremic pruritus remains unknown. This study investigated the impact of S. aureus nasal carriage on the prevalence and severity of uremic pruritus and its association with subsequent infection in HD patients.

METHODS

We conducted a prospective cohort study from April 2019 to January 2020, enrolling 100 HD patients in Taiwan. Nasal swab cultures determined S. aureus colonization status. Odds ratios (ORs) for uremic pruritus, effect estimates for pruritus intensity, and hazard ratios (HRs) for subsequent S. aureus infections were assessed.

RESULTS

S. aureus nasal carriage was detected in 24% of HD patients and was more prevalent among those with uremic pruritus (32.7% vs. 13.3%, p = 0.02). S. aureus nasal carriage was associated with a significantly increased risk of uremic pruritus (OR: 4.21; 95% confidence interval [CI], 1.34-13.24, p < 0.01) and correlated with higher pruritus intensity (effect estimate: 1.18; 95% CI, 0.05-2.30; p = 0.04). During a median follow-up of 8.97 months, five patients developed S. aureus infections. While S. aureus nasal carriage showed a trend toward an increased risk of subsequent infection, the finding did not reach statistical significance (HR: 50.93; 95% CI, 0.62-4181.02; p = 0.08).

CONCLUSIONS

S. aureus nasal carriage is significantly associated with the prevalence and severity of uremic pruritus in HD patients. Larger studies are needed to confirm its role in infection risk and to explore decolonization as a potential therapeutic strategy.