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Staphylococcus aureus infections during peritoneal dialysis
1Institute of Nephrology, Cardiff Royal Infirmary, Wales, UK.
Abstract:
Peritoneal dialysis is in widespread use for the treatment of chronic renal failure. Infection is still one of the major complications and can include peritonitis and pericannular problems. The rate of peritonitis is currently 0.5 episodes per patient year with disconnect systems, and there are about 0.4 exit-site infections (ESIs) per patient year. ESI is associated with a high rate of catheter removal and replacement. Staphylococcus aureus is a common cause of peritonitis and accounts for more than half of all ESIs. Nasal carriage of S. aureus is associated with a much higher rate of ESI. Treatment of ESIs is unsatisfactory. The type of exit-site care, however, does influence the rate of infection and prophylaxis with oral rifampicin and local or nasal mupirocin has been claimed to reduce ESIs. A large multicentre double-blind trial of nasal mupirocin has just been completed and preliminary results show a reduction in the incidence of S. aureus-induced ESI. The cost benefits of such a regimen are being evaluated.
Insights
Peritoneal dialysis patients face infection risks, particularly exit-site infections (ESIs) caused by Staphylococcus aureus. Nasal mupirocin prophylaxis shows promise in reducing S. aureus ESIs, though cost-effectiveness is under evaluation.
Area of Science:
- Nephrology
- Infectious Diseases
- Medical Microbiology
Background:
- Peritoneal dialysis is a common treatment for chronic renal failure.
- Infections, including peritonitis and exit-site infections (ESIs), are significant complications.
- Staphylococcus aureus is a primary cause of ESIs, with nasal carriage increasing risk.
Purpose of the Study:
- To evaluate the efficacy of nasal mupirocin in reducing Staphylococcus aureus-induced exit-site infections in peritoneal dialysis patients.
- To assess the impact of exit-site care on infection rates.
Main Methods:
- A large, multicenter, double-blind trial was conducted.
- Participants received either nasal mupirocin or a placebo for prophylaxis.
- Infection rates, specifically ESIs, were monitored.
Main Results:
- Preliminary results indicate a reduction in the incidence of S. aureus-induced ESIs with nasal mupirocin prophylaxis.
- The study evaluated the influence of exit-site care on infection rates.
Conclusions:
- Nasal mupirocin prophylaxis appears effective in decreasing Staphylococcus aureus exit-site infections in peritoneal dialysis patients.
- Further evaluation of cost benefits for this prophylactic regimen is ongoing.