Staphylococcus aureus septic arthritis in patients on hemodialysis treatment.
We retrospectively reviewed hospital discharge diagnoses of septic arthritis over an 11-year period (1982 through 1992) at 3 medical centers; 11 episodes of septic arthritis were identified in patients on hemodialysis treatment. Of the 11 episodes, 9 were caused by Staphylococcus aureus; in 8 of 9, the blood cultures were positive for the organism and the infection was monoarticular. Concurrent infection of the dialysis access site occurred in 4 cases. Two patients died (22%). We postulate that repeated skin trauma and contact with health care personnel and facilities result in a high rate of nasal carriage of S aureus and, hence, an increased risk of bacteremia with its attendant complications such as septic arthritis. The use of mupirocin nasal ointment is reported to eradicate or suppress carriage in a high percentage of patients; some studies report that long-term suppressive therapy reduces the frequency of S aureus bacteremia.
Slaughter
S
S
Department of Medical Education, Providence Medical Center, Portland, OR 97213-2967, USA.
Dworkin
R J
RJ
Gilbert
D N
DN
Leggett
J E
JE
Jones
S
S
Bryant
R
R
Martin
M A
MA
D000281:Administration, Intranasal; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D001170:Arthritis, Infectious / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology* / Q000517:prevention & control
D000900:Anti-Bacterial Agents; D016712:Mupirocin