title: Prevalence of peritonitis-associated coagulase-negative staphylococci on the skin of continuous ambulatory peritoneal dialysis patients.
abstract: The predominance of coagulase-negative staphylococci as normal skin flora is thought to be a factor in their association with episodes of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. We investigated the prevalence of peritonitis-associated strains on the skin of 28 patients undergoing peritoneal dialysis. Coagulase-negative staphylococci were the most frequently isolated organisms, comprising 47% of peritoneal dialysis fluid isolates and 59% of body site isolates. A total of 142 coagulase-negative staphylococci were speciated, tested for their antimicrobial sensitivity and slime production, and identified by phage typing and plasmid-profile analysis. Staphylococcus epidermidis was the most commonly identified species from both peritoneal dialysis fluid (73%) and body sites (53%). Multiple antibiotic resistance was common, and the greater proportion of isolates were resistant to methicillin; 63.6% of peritoneal dialysis fluid isolates and 61.7% of body-site isolates. S. haemolyticus isolates were significantly more resistant to methicillin than other species. By phage typing and plasmid-profile analysis it was shown that peritonitis was rarely caused by skin-colonizing strains. In only 3 of 14 patients were peritonitis-associated strains isolated as skin colonizers, and no patients developed peritonitis due to organisms previously isolated as skin colonizers.
authors.affiliation: Department of Infectious Diseases, University of Sydney, NSW, Australia.
authors.forename: M A
authors.initials: MA
authors.lastname: Beard-Pegler
authors.forename: C L
authors.initials: CL
authors.lastname: Gabelish
authors.forename: E
authors.initials: E
authors.lastname: Stubbs
authors.forename: C
authors.initials: C
authors.lastname: Harbour
authors.forename: J
authors.initials: J
authors.lastname: Robson
authors.forename: M
authors.initials: M
authors.lastname: Falk
authors.forename: R
authors.initials: R
authors.lastname: Benn
authors.forename: A
authors.initials: A
authors.lastname: Vickery
mesh_terms: D001434:Bacteriophage Typing / Q000379:methods; D002478:Cells, Cultured; D003030:Coagulase; D006801:Humans; D008712:Methicillin / Q000627:therapeutic use; D010403:Penicillin Resistance; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000382:microbiology*; D010957:Plasmids; D012867:Skin / Q000382:microbiology*; D013210:Staphylococcus / Q000145:classification / Q000302:isolation & purification*; D013212:Staphylococcus epidermidis / Q000302:isolation & purification
chemical_list: D003030:Coagulase; D008712:Methicillin