Nasal and cutaneous flora among hemodialysis patients and personnel: quantitative and qualitative characterization and patterns of Staphylococcal carriage.

Staphylococcal sepsis is a leading cause of morbidity and mortality among chronic hemodialysis (HD) patients. We studied nasal and cutaneous flora of HD patients and personnel and their patterns of staphylococcal carriage. HD patients had significantly increased cutaneous total bacterial colony counts (p less than 0.01) as well as both nasal (p less than 0.0001) and cutaneous (p less than 0.0001) carriage of Staphylococcus aureus compared to personnel. Cutaneous staphylococcal carriage could be significantly correlated with nasal carriage (p less than 0.01). Cutaneous streptococcal species and gram-negative bacilli were not different between patients and personnel. Staphylococcal phage typing of nasal isolates from staphylococcal carriers revealed a mean of 90% of isolates from each subject belonging to a predominant phage type. Predominant nasal staphylococcal phage types corresponded with respective predominant cutaneous phage types in 93% of HD patients carriers. These studies substantiate autoinoculation of S. aureus from the nasal vestibule to the skin overlying the vascular access site.