Nasal carriage and peritonitis by Staphylococcus aureus in patients on continuous ambulatory peritoneal dialysis: a prospective study.

OBJECTIVE

To establish whether or not patients on continuous ambulatory peritoneal dialysis (CAPD) using current infection control measures who are nasal carriers of Staphylococcus aureus are at risk for the development of S. aureus peritonitis.

DESIGN

A prospective 22-month study analyzing nasal and skin/nasal (i.e., nasal and/or exit-site) carrier status for S. aureus and peritonitis episodes. Nasal swab cultures for S. aureus were taken with 1- to 3-month intervals; swab cultures from the catheter exit site were taken only when infection was suspected.

SETTING

Renal unit, tertiary-care center.

PATIENTS

All patients on CAPD at our center that could be observed during at least 2 months.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Nasal and skin/nasal carrier status, occurrence of peritonitis.

RESULTS

Of 54 enrolled patients, 31 (57%) were nasal carriers for S. aureus: 6 of these 31 developed S. aureus peritonitis as opposed to none of 23 non-carriers (p = 0.03). The S. aureus peritonitis rate in 28 skin/nasal carriers was increased when compared to non-carriers (p = 0.02), but there was no difference between chronic and intermittent skin/nasal carriers (p = 0.63).

CONCLUSIONS

In our population, nasal carriers are at increased risk for the development of S. aureusperitonitis. Further studies should evaluate the effect of eradication of nasal carriage of S. aureus and the effect of additional preventive hygienic measures on the occurrence of peritonitis by S. aureus.