Staphylococcus Aureus Nasal Carriage, Exit-Site Infection and Catheter Loss in Patients Treated with Continuous Ambulatory Peritoneal Dialysis (CAPD)

Abstract

Over a three-year period, 217 episodes of bacterial peritonitis occurred in 183 patient years. Thirty-seven episodes were due to Staphylococcus aureus and 19 (51 %) of these required removal of the catheter to eradicate infection. This compared with catheter loss in 4/63 (6.3%) coagulase negative staphylococci infections ( p < 0.001); 7/67 (9.5%) culture negative peritonitis ( p < 0.001); and 10/30 (33.3%) episodes due to gram-negative organisms ( p < 0.05). Over half (51.3%) the episodes due to S. aureus were associated with exit-site infections, and this rose to 100% (10/10) with recurrent peritonitis ( p < 0.01). A prospective analysis of nasal carriage and exit-site infections due to S. aureus was carried out in 87 patients. Exit-site infections were present in 21 (24%), almost entirely due to different strains as judged by sensitivity patterns and phage typing. Nasal carriage, defined as two positive swabs within the study period, was present in 20 (23%) patients. Fourteen (70%) of these had exit site infections due to the same strain as that isolated from the nose, whereas no patient grew different strains from either site. Nasal carriage increased the risk of infection sixfold ( p < 0.001).

Prevalence and treatment of Staphylococcus aureus colonization in patients with mycosis fungoides and Sézary syndrome

“…eczema or pediculosis. 11 High rates of S. aureus carriage are reported in patients with atopic dermatitis, psoriasis, dialysis and human immunodeficiency virus infection 7,8,[12][13][14][15][16][17][18][19][20][21][22][23][24] (Table 1) but the rate of S. aureus colonization in patients with CTCL (MF ⁄SS) is unknown.…”

CAPD Peritonitis: A Critical Appraisal of Prophylactic Strategies

“…Much higher rates of catheter loss have been reported (40) for peritonitis due to Staphylococcus aureus, Pseudomonas and gram negative peritonitis than for peritonitis due to Staphylococcus epidermidis and other gram positive organisms. Davies et al (41) reported a 51% rate of catheter loss for Staphylococcus aureus and 33% for gram negative organisms compared to 6% for Staphylococcus epidermidis. Technique failure following Staphylococcus epidermidis peritonitis occurred in 3-5% of patients compared to l 3-15% for Staphylococcus aureus, Pseudomonas and gram negative organisms (40).…”

“…The probability of Staphylococcus aureus peritonitis is about 15% per year (24). Between 20-50% of these patients, representing 3-7.5%, of all CAPD patients will require removal of the peritoneal catheter (40,41). This is clearly an important clinical problem.…”

“…The incidence of Staphylococcus aureus peritonitis was 69% among chronic carriers, 33% among intermittent carriers and 0% among noncarriers. In another study (41), 23% of CAPD patients were chronic carriers of nasal Staphylococcus aureus (defined as at least 2 positive nares cultures on two monthly testings over an eight month period). The nasal carrier state increased the risk of ESI by 6.7 fold.…”

Clinical effectiveness of different approaches to peritoneal dialysis catheter exit-site care

“…From this perspective, there is an argument for inclusion in this review of studies pertaining to: • types of catheters; 14,15 • surgical insertion techniques; [16][17][18] • systemic antibiotics; 10 • nasal treatment of Staphylococcus aureus colonisation. [19][20][21][22][23][24] However, the primary intention of this review was to examine the interventions most directly pertaining to exitsite care as it might be practised by clinicians or patients in their own homes. This difference might best be explained by the inclusion of studies that evaluated the application of mupirocin to the exit site, yet excluded studies that examined mupirocin application to the nares.…”