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Elimination of Nasal Carriage of Staphylococcus aureus in Hemodialysis Patients

Published online by Cambridge University Press:  02 January 2015

Jan A.J.W. Kluytmans ,
Marie-Jose Manders ,
Erik van Bommel  and
Henri Verbrugh
Jan A.J.W. Kluytmans*
Affiliation:
Department of Clinical Microbiology, and the Department of Nephrology, University Hospital Rotterdam, The Netherlands
Marie-Jose Manders
Affiliation:
Department of Clinical Microbiology, and the Department of Nephrology, University Hospital Rotterdam, The Netherlands
Erik van Bommel
Affiliation:
Department of Clinical Microbiology, and the Department of Nephrology, University Hospital Rotterdam, The Netherlands
Henri Verbrugh
Affiliation:
Department of Clinical Microbiology, and the Department of Nephrology, University Hospital Rotterdam, The Netherlands
*
Department of Clinical Microbiology, Ignatius Hospital, PO Box 90158, 4800 RK Breda, The Netherlands
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Abstract

Objective:

To study the efficacy of mupirocin for the elimination of nasal carriage of Staphylococcus aureus in hemodialysis patients.

Design:

The efficacy of mupirocin was studied in a prospectively followed cohort. The effect of this intervention on the rate of S aureus bacteremia was evaluated using a historic control group.

Setting:

Patients on the hemodialysis unit of the University Hospital Rotterdam, a tertiary referral center.

Patients:

The study group consisted of consecutive patients on hemodialysis from February 1, 1992, until November 1, 1993. They were screened by taking nasal cultures monthly during their time on hemodialysis. If S aureus was isolated, treatment with mupirocin nasal ointment was initiated. The control group consisted of patients treated on the same hemodialysis unit from January 1, 1990, until January 1, 1992.

Results:

The study group consisted of 226 patients, of whom 172 were evaluated to determine the efficacy of mupirocin. Sixty-seven (39%) were identified as nasal carriers. Following the initial treatment, 66 nasal cultures (98.5%) became negative. After 3 months and 6 months, respectively, 63 (94%) and 61 (91%) of the treated carriers had negative cultures. The rate of bacteremia (defined as the number of episodes of 5 aureus bacteremia per patient-year on hemodialysis) was significantly lower among the 226 patients in the study group (0.04 per patient-year) than among the 273 patients in the control group (0.25 per patient year; P <.001). Development of resistance and adverse effects were not observed.

Conclusions:

Mupirocin nasal ointment effectively eliminates nasal carriage of 5 aureus in patients on hemodialysis. This was associated with a significant reduction of the incidence of 5 aureus bacteremia, as compared to historic controls.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 12 , December 1996 , pp. 793 - 797
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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References

1. Yu, VL, Goetz, A, Wagener, M, et al. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. N Engl J Med 1986;315:91–96.CrossRefGoogle ScholarPubMed
2. Bradley, JR, Evans, DB, Calne, RY. Long-term survival in haemodialysis patients. Lancet 1987;I:295–296.CrossRefGoogle Scholar
3. Kaplowitz, LG, Comstock, JA, Landwehr, DM, Dalton, HP, Mayhall, CG. Prospective study on microbial colonization of the nose and skin and infection of the vascular access site in hemodialysis patients. J Clin Microbiol 1988;26:1257–1262.CrossRefGoogle ScholarPubMed
4. Chow, JW, Yu, VL. Staphylococcus aureus nasal carriage in hemodialysis patients. Arch Intern Med 1989;149:1258–1262.CrossRefGoogle ScholarPubMed
5. Goldblum, SE, Reed, WP, Ulrich, JA, Goldman, RS. Staphylococcal carriage and infections in hemodialysis patients. Nephrol Dial Transplant 1978;7:1140–1148.Google Scholar
6. Fekety, FR Jr. The epidemiology and prevention of staphylococcal infection. Medicine 1964;43:593.CrossRefGoogle ScholarPubMed
7. Aly, R, Shinefield, HR, Litz, C, Maibach, HI. Role of teichoic acid in the binding of Staphylococcus aureus to nasal epithelial cells. J Infect Dis 1980;141:463–465.CrossRefGoogle ScholarPubMed
8. Berman, DS, Schaefler, S, Simberkoff, MS. Staphylococcus aureus colonization in intravenous drug abusers, dialysis patients, and diabetes. J Infect Dis 1978;155:829–831.CrossRefGoogle Scholar
9. Tuazon, CU, Perez, A, Kishaba, T, Sheagren, JN. Staphylococcus aureus among insulin-injecting diabetic patients. An increased carriage rate. JAMA 1975;231:1272.CrossRefGoogle ScholarPubMed
10. Kirmani, N, Tuazon, CU, Murray, HW, Parrish, AE, Sheagren, JN. Staphylococcus aureus carriage rate of patients receiving long-term hemodialysis. Arch Intern Med 1978;138:1657–1659.CrossRefGoogle ScholarPubMed
11. Tuazon, CU, Sheagren, JN. Increased rate of carriage of Staphylococcus aureus among narcotic addicts. J Infect Dis 1974;129:725.CrossRefGoogle ScholarPubMed
12. Weinstein, HJ. The relation between the nasal-staphylococcal carrier state and the incidence of postoperative complications. N Engl J Med 1959;260:1303–1308.CrossRefGoogle ScholarPubMed
13. Luzar, MA, Coles, GA, Faller, B, et al. Staphylococcus aureus nasal carriage and infection in patients on continuous ambulatory peritoneal dialysis. N Engl J Med 1990;322:505–509.CrossRefGoogle ScholarPubMed
14. Boelaert, JR, DeSmedt, RA, De Baere, YA, et al. The influence of calcium mupirocin nasal ointment on the incidence of Staphylococcus aureus infections in hemodialysis patients. Nephrol Dial Transplant 1989;4:278–281.CrossRefGoogle Scholar
15. Holton, DL, Nicolle, LE, Diley, D, Bernstein, K. Efficacy of mupirocin nasal ointment in eradicating Staphylococcus aureus nasal carriage in chronic hemodialysis patients. J Hosp Infect 1991;17:133–137.CrossRefGoogle Scholar
16. Bulanda, M, Gruszka, M, Heczko, B. Effect of mupirocin on nasal carriage of Staphylococcus aureus . J Hosp Infect 1989;14:117–124.CrossRefGoogle ScholarPubMed
17. Doebbeling, BN, Breneman, DL, Neu, HC, et al. Elimination of Staphylococcus aureus nasal carriage in health care workers: analysis of six clinical trials with calcium mupirocin ointment. Clin Infect Dis 1993;17:466–474.CrossRefGoogle ScholarPubMed
18. Reagan, DR, Doebbeling, BN, Pfaller, MA, et al. Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991;114:101–106.CrossRefGoogle ScholarPubMed
19. Gilbart, J, Perry, CR, Slocombe, B. High-level mupirocin resistance in Staphylococcus aureus: evidence for two distinct isoleucyl-TRNA synthetases. Antimicrob Agents Chemother 1993;37:32–38.CrossRefGoogle ScholarPubMed
20. Barrett, SP. The value of nasal mupirocin in containing an outbreak of methicillin-resistant S aureus in an orthopaedic unit. J Hosp Infect 1990;15:137–142.CrossRefGoogle Scholar
21. Voss, A, Milatovic, D, Wallrauch-Schwartz, C, Rosdahl, VT, Braveny, I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13:50–55.CrossRefGoogle ScholarPubMed
22. Kauffman, CA, Terpenning, MS, He, X, et al. Attempts to eradicate methicillin-resistant Staphylococcus aureus from a long-term care facility with the use of mupirocin ointment. Am J Med 1993;94:371–378.CrossRefGoogle ScholarPubMed
23. Wenzel, RP. Preoperative antibiotic prophylaxis. N Engl J Med 1992;326:337–339.CrossRefGoogle ScholarPubMed