Staphylococcus aureus colonization and infection in patients on continuous ambulatory peritoneal dialysis

Staphylococcus aureus is the most common cause of peritonitis in patients undergoing peritoneal dialysis in Brazil. Using restriction endonuclease analysis of plasmid DNA, we investigated the importance of chronic carriage of S. aureus in the development of peritonitis in patients on continuous ambulatory peritoneal dialysis at the Division of Nephrology, Escola Paulista de Medicina, Sao Paulo, Brazil. A total of 117 isolates (30 patients) of S. aureus were available for typing, including 51 isolates (22 patients) from the nares, 58 isolates (27 patients) from pericatheter skin, and 8 isolates (6 patients) from peritoneal fluid, from patients with peritonitis. Restriction endonuclease subtyping showed that although most patients harbored more than one subtype of S. aureus, in the majority of patients nasal and/or pericatheter skin isolates with identical restriction endonuclease digest patterns were recovered on more than one occasion. Furthermore, 95% of patients with both nasal and pericatheter colonization were colonized with the same subtypes at both sites. All of the patients with peritonitis were infected with a subtype which colonized the nares, pericatheter skin, or both. These results demonstrate the importance of an endogenous source of S. aureus in the development of continuous ambulatory peritoneal dialysis-associated peritonitis.