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Elimination of Staphylococcus aureus in hemodialysis patients
J Bommer1, W Vergetis, K Andrassy
1Department of Internal Medicine, University of Heidelberg, Germany.
Abstract:
Staphylococcus aureus infection and its complications are of great concern in the care of hemodialysis patients. Nasal contamination with S. aureus seems to be the main source of cutaneous contamination. The decontamination and recontamination of the skin of hemodialysis patients after using mupirocin nasal ointment was followed in a placebo control study. After 10 days of therapy with mupirocin nasal ointment, 25 of 33 (73%) patients were free of nasal S. aureus contamination in the nares (control subjects 2 of 21, 10%). At the same time, the prevalence of positive skin cultures for S. aureus decreased from 30 of 33 (90%) to 11 of 33 (33%) patients. However, during the ensuing 130 days, 14 of 25 (58%) patients with negative nasal cultures became recontaminated, while the skin became recontaminated in 11 of 22 (50%) patients. In 10 of 14 S. aureus recontaminated patients the original S. aureus lysotype was documented by specific phage reaction. Four of fourteen patients had a new S. aureus lysotype. Mupirocin nasal ointment eradicated S. aureus transiently in 75% of the patients but continuously in only 11 of 33 (30%) patients.
Insights
Mupirocin nasal ointment effectively clears Staphylococcus aureus from hemodialysis patients noses and skin initially. However, recontamination is common, highlighting the need for sustained strategies against S. aureus infections in this vulnerable group.
Area of Science:
- Infectious Diseases
- Nephrology
- Microbiology
Background:
- Staphylococcus aureus infections pose significant risks for hemodialysis patients.
- Nasal carriage of S. aureus is a primary source for skin contamination in these patients.
Purpose of the Study:
- To evaluate the efficacy of mupirocin nasal ointment in decontaminating S. aureus in hemodialysis patients.
- To assess the rates of recontamination of nasal and skin S. aureus carriage after treatment.
Main Methods:
- A placebo-controlled study was conducted on hemodialysis patients.
- Mupirocin nasal ointment was administered for 10 days.
- Nasal and skin cultures were monitored for S. aureus before, during, and up to 130 days after treatment.
Main Results:
- Mupirocin nasal ointment achieved initial S. aureus eradication in 73% of patients' nares and reduced skin carriage from 90% to 33%.
- Within 130 days, 58% of patients experienced nasal recontamination, and 50% had skin recontamination.
- S. aureus recontamination often involved the original strain, confirmed by phage typing.
Conclusions:
- Mupirocin nasal ointment provides transient S. aureus eradication in hemodialysis patients.
- Continuous eradication was achieved in only 30% of patients, indicating a high rate of recontamination.
- Strategies to prevent S. aureus recontamination are crucial for long-term management in hemodialysis patients.