Staphylococcal infections in a hemodialysis unit.

Experience with Staphylococcus aureus infections in a hemodialysis unit in which arteriovenous fistulas were used routinely for dialysis is reviewed, including an epidemic involving multiple bacteriophage types. Most infections involved the fistula site and were associated with bacteremia, although bacteremia without an obvious fistula infection did occur. Despite recurrent bacteremia, endocarditis was not documented, and patients did not develop teichoic acid antibodies as measured by an immunodiffusion technique. Patients with fistula infections responded to antibiotic therapy and did not require removal of the fistula except in two patients whose fistulas ruptured. Patients with shunt infections had to have their shunts removed to control infection. The epidemic developed after the hemodialysis unit was moved into a larger area to facilitate an increasing number of patients and after diabetic patients were admitted to the dialysis program. Both autoinfection and cross-infection contributed to the epidemic, which resolved with improvements in aseptic techniques. A culture survey indicated that the nasal carriage of staphylococci was not unusually high during the epidemic. This report emphasizes that staphylococcal infections remain a problem in continually changing hospital environments.