Carrier-status for nasal staphylococci does not predict infections in CAPD patients

It has been reported that nasal carriage of staphylococci may contribute to infections of the continuous ambulatory peritoneal dialysis (CAPD) catheter exit site or cause peritonitis due to this pathogen. Recently, a nasal ointment to eradicate these bacteria in patients and staff has been marketed with the implication that this treatment may reduce infection rates. In this study, we investigated 37 patients treated with CAPD for a mean of 38.8 +/- 6.4 months. Presence of nasal carriage of staphylococci was assessed using standard nasal swab techniques and related to bacteria identified at the time of previous infections. Results were analyzed using Spearman rank order correlation and linear regression analysis. In 119.5 patient years at risk, 50 infections with staphylococci (24 episodes of peritonitis and 26 exit-site infections) were evaluated. Nineteen patients were carriers of S. aureus or S. epidermidis; 6 patients were carrying both species. There was no correlation of current nasal carriage of staphylococci with previous infection. Although 23 of 37 patients were carriers, 14 of these never had infections due to nasal staphylococci. Only in 14 of 50 infections were bacteria species the same in the nose and at the site of infection. We conclude that prospective trials demonstrating a reduction of CAPD-related infections are needed before general use of prophylactic nasal antibiotic treatment can be recommended in these patients.