Staphylococcus aureus nasal carriage in children receiving long-term peritoneal dialysis.
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.
Kingwatanakul
P
P
Children's Mercy Hospital, Kansas City, Missouri, USA.
Warady
B A
BA
D000281:Administration, Intranasal; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002353:Carrier State / Q000175:diagnosis; D002408:Catheters, Indwelling / Q000009:adverse effects; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D016712:Mupirocin / Q000008:administration & dosage; D009666:Nose / Q000382:microbiology*; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010538:Peritonitis / Q000209:etiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents; D016712:Mupirocin