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[Staphylococcus aureus colonization and risk of developing a subsequent peritonitis episode caused by an identical
Guadalupe Miranda-Novales1, Rafael Aburto y-Huesca, Blanca Leaños-Miranda
1Unidad de Investigación Médica en Epidemiología Hospitalaria, Hospital de Pediatría, México DF, México.
Insights
Staphylococcus aureus (SA) nasal or exit site carriage does not increase peritonitis risk in pediatric continuous ambulatory peritoneal dialysis (CAPD) patients. Monitoring or eradicating SA carriers is not recommended based on these findings.
Area of Science:
- Nephrology
- Infectious Disease Epidemiology
- Pediatric Critical Care
Context:
- Pediatric patients with end-stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD) are susceptible to peritonitis.
- Staphylococcus aureus (SA) is a common pathogen causing peritonitis in CAPD patients.
- Understanding the source of SA infections is crucial for prevention strategies.
Purpose:
- To determine the risk of peritonitis caused by an identical Staphylococcus aureus (SA) strain in pediatric CAPD patients.
- To investigate the association between SA carriage at nasal and exit sites and subsequent peritonitis episodes.
Summary:
- A longitudinal survey followed 29 pediatric CAPD patients and their mothers, collecting nasal, exit site, and hand swabs.
- SA strains were isolated and compared using PFGE during peritonitis episodes.
- Results showed no significant increased risk of peritonitis from SA carriage at nasal or exit sites.
Impact:
- Findings challenge the routine monitoring and eradication of SA nasal or exit site carriage in pediatric CAPD patients.
- This study suggests that current recommendations for SA carrier management in this population may not be effective.
- The research provides evidence to re-evaluate preventative strategies for SA peritonitis in pediatric CAPD.
Objective:
To determine the risk of pediatric end stage renal disease patients undergoing continuous ambulatory peritoneal dialysis to develop a subsecuent peritonitis episode caused by an identical Staphylococcus aureus (SA) strain.
Methods:
Longitudinal survey carried out in a CAPD center at the nephrology department of a tertiary care (reference) pediatric hospital. At recruitment, swabs were collected from the nares, exit site, and hands, respectively from 29 patients who were followed-up for a mean period of 369 +/- 80 days (range 224-516 days), and from the nares and hands of their mothers. Isolated SA strains were kept in BHI glycerol at -20 degrees C for subsequent analysis. Peritonitis episodes were monitored and registered. When a SA strain was isolated from the dialysate effluent it was compared with the preexisting strain by PFGE.
Results:
We report 7 SA-mediated peritonitis episodes among 6 patients. Only one of these patients was a previous nasal carrier, and 2 were previous exit site carriers of the same SA strain. The relative risk of developing a peritonitis episode caused by a preexistent SA strain colonizing the exit site was 0.948. The relative risk of developing a peritonitis episode caused by a preexistent SA strain colonizing the nares was 0.525.
Conclusions:
SA carriers do not appear to be at higher risk of developing peritonitis by an SA related strain than non-carriers. Our results do not lend support to the recommendation of monitoring nasal or exit site carrier status in CAPD patients. The need of attempting to eradicate SA from nose or exit site is also questioned.
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