Staphylococcus aureus infections in haemodialysis patients: pathophysiology and use of nasal mupirocin for prevention.
Staphylococcus aureus is the most frequently (42%) isolated micro-organism during bacteraemic episodes in haemodialysis patients. Nasal carriage of S. aureus is of major importance in determining the risk of subsequent infections. Indeed, nasal carriage of S. aureus is highly prevalent in uraemic patients from the onset of maintenance dialysis therapy. The strains isolated simultaneously from the nares and the hands are usually the same. Likewise, infecting S. aureus strains and those isolated from nasal surveillance cultures obtained in the same patient are usually similar. S. aureus infections in haemodialysis patients are thus mostly to be considered as auto-infections. The nares are therefore an elective site for the prevention of S. aureus infections in haemodialysis patients. This has been demonstrated with oral rifampin, and more recently with nasal mupirocin, which is highly effective. Long-term application of nasal mupirocin (e.g. once per week) is cost-effective and is only rarely associated with the emergence of mupirocin-resistance in S. aureus.
Boelaert
J R
JR
Unit of Renal and Infectious Diseases, Algemeen Ziekenhuis St. Jan, Brugge, Belgium.
Van Landuyt
H W
HW
De Baere
Y A
YA
Deruyter
M M
MM
Daneels
R F
RF
Schurgers
M L
ML
Matthys
E G
EG
Gordts
B Z
BZ
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D016712:Mupirocin / Q000627:therapeutic use*; D009666:Nose / Q000382:microbiology*; D006435:Renal Dialysis / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000209:etiology* / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects*
D000900:Anti-Bacterial Agents; D016712:Mupirocin