Kingwatanakul P, Warady B A
Children's Mercy Hospital, Kansas City, Missouri, USA.
Adv Perit Dial. 1997;13:281-4.
The frequency of Staphylococcus aureus (SA) nasal carriage and the impact of antibiotic therapy remain undefined in children receiving long-term peritoneal dialysis (PD). We obtained a nasal culture for SA every 4-12 weeks in 21 children (mean age 7.03 +/- 5.8 years) receiving PD from January 1992 to August 1996 (total of 35.3 patient-years). In each case, SA nasal carriage (NSA+) was treated with intranasal mupirocin for 7 days. NSA+ was detected in 13 patients (61.9%) who received dialysis for 28.9 patient-years. Eight (61.5%) of 13 patients became NSA+ during the initial 3 months of dialysis. Seven (53.8%) of the NSA+ patients had 11 exit-site infections (ESI) and one episode of peritonitis (0.42 total infections/patient-year) due to SA. The 8 patients without SA nasal carriage (NSA-) received dialysis for 6.4 patient-years. None of the NSA-patients had an ESI or peritonitis with SA. Finally, the incidence of non-SA infections in the NSA+ and NSA- groups was not different (0.62 vs 0.31 total infections/patient-year, p > 0.05). In conclusion, there appears to be an association between SA nasal carriage and SA ESI in children on PD. The risk of SA peritonitis in NSA+ patients treated with mupirocin may be minimal. The risk of SA nasal carriage may increase with time on dialysis.
在接受长期腹膜透析（PD）的儿童中，金黄色葡萄球菌（SA）鼻腔定植的频率以及抗生素治疗的影响尚不清楚。我们在1992年1月至1996年8月期间，对21名接受PD治疗的儿童（平均年龄7.03±5.8岁）每4 - 12周进行一次鼻腔SA培养（总计35.3患者年）。在每种情况下，SA鼻腔定植阳性（NSA +）的患者接受鼻内莫匹罗星治疗7天。在接受透析28.9患者年的13名患者（61.9%）中检测到NSA +。13名患者中有8名（61.5%）在透析的最初3个月内变为NSA +。7名（53.8%）NSA +患者因SA发生了11次出口部位感染（ESI）和1次腹膜炎（每患者年0.42次总感染）。8名无SA鼻腔定植（NSA -）的患者接受透析6.4患者年。NSA -患者中无一例发生SA引起的ESI或腹膜炎。最后，NSA +组和NSA -组中非SA感染的发生率无差异（每患者年总感染率分别为0.62和0.31，p>0.05）。总之，PD儿童中SA鼻腔定植与SA ESI之间似乎存在关联。用莫匹罗星治疗的NSA +患者发生SA腹膜炎的风险可能最小。SA鼻腔定植的风险可能随着透析时间的延长而增加。
