Effect of Local Mupirocin Application on Exit-Site Infection and Peritonitis in an Indian Peritoneal Dialysis Population

Background

Staphylococcus aureus-associated peritonitis and catheter exit-site infections (ESIs) are important causes of hospitalization and catheter loss in patients undergoing chronic peritoneal dialysis. Intranasal and topical use of mupirocin has been found to be an effective strategy in decreasing S. aureus-related infectious complications in persons who are carriers of S. aureus; however, there is no consensus regarding the prophylactic use of mupirocin irrespective of carrier status. We aimed to determine the potential effectiveness of application of mupirocin cream at the catheter exit site in preventing ESI and peritonitis irrespective of carrier status in a tropical country such as India.

Methods

This prospective historically controlled study was done in a total of 40 patients. From August 2003, all patients, incident and prevalent, were instructed to apply 2% mupirocin cream daily to the exit site instead of the older practice of povidone-iodine and gauze dressing. Patients were not screened to determine whether they were S. aureus carriers. The infection-related data for 1 year, until July 2004, were compared with the historical control, which was infection-related data for the year preceding the year of mupirocin application.

Results

Mean age of the study population was 62 years, with 61.8% being male and 64.3% being diabetic. Local application of mupirocin led to a significant reduction in the incidence density per patient-month of both ESI and peritonitis compared to controls (0.15 vs 0.37 and 0.37 vs 0.67, p = 0.01 for both). This amounted to a relative reduction of 60.5% and 55% respectively. ESI and peritonitis due to S. aureus were also significantly lower in the study group compared to controls (incidence density per patient-month 0.05 vs 0.13 and zero vs 0.17 respectively, p < 0.01 for both). There occurred no catheter removal due to infection-related complications during the study period compared to two during the control period. None of the patients reported a mupirocin-related adverse effect.

Conclusions

Daily application of mupirocin at the exit site is a well-tolerated and effective strategy in reducing the incidence of ESI and peritonitis in a tropical country such as India. It can thus significantly reduce morbidity, catheter loss, and transfer to hemodialysis in peritoneal dialysis patients.

Intranasal Mupirocin does not Prevent Exit-Site Infections in Children Receiving Peritoneal Dialysis

← Objective

Exit-site infections (ESI) in patients receiving peritoneal dialysis (PD) often progress to tunnel infections and peritonitis, sometimes requiring PD catheter removal. Staphylococcus aureus (SA) is the commonest cause of ESI. In this study, we evaluated the efficacy of mupirocin nasal ointment in preventing ESI in children receiving PD.

← Design

A single-center study.

← Setting

Tokyo Metropolitan Kiyose Children's Hospital.

← Patients

47 outpatients [33 males; age 11.7 ± 4.9 years (mean ± SD)] participated in this study between April 1998 and March 1999 at Tokyo Metropolitan Kiyose Children's Hospital. The total study period comprised 399 patient-months. Nasal cultures were performed every month. Nasal carriers of SA applied intranasal mupirocin ointment twice per day for 7 days. We compared the incidence of ESI in the intervention group to 77 historical controls (48 males; age 7.6± 5.1 years); the total control period comprised 2802 patient-months.

← Results

32 patients were identified as SA nasal carriers on one or two occasions (32/47 or 68%). The total period of SA nasal carriage was 95 patient-months (95/399 or 24%). The incidence of ESI caused by SA among all ESI cases was 20/28 (71%) in the study group and 115/151 (76%) in the control. There was no significant difference. The incidence of peritonitis caused by SA among all peritonitis cases was 3/6 (50%) in the study group and 17/42 (40%) in the control group, showing no significant difference. There was no significant difference in the overall incidence of ESI, peritonitis, or replacement of PD catheters between the study group and the control group.

← Conclusion

Intranasal mupirocin ointment did not prevent ESI. Further study is needed to develop an effective method of preventing ESI in pediatric PD patients.

Exit-Site Infection in Children on Peritoneal Dialysis: Comparison of Two Types of Peritoneal Catheters

Objective

To review our experience with two types of peritoneal catheters, the standard Tenckhoff catheter and the swan-neck presternal catheter (SNPC).

Design

A retrospective study was undertaken to compare exit-site infection (ESI) rates using two types of peritoneal catheters in children.

Setting

Medical University of Warsaw, Warsaw, Poland.

Patients

During the past 10 years, 60 peritoneal catheters were implanted in 50 children with end-stage renal failure: 46 straight, double-cuffed Tenckhoff in 37 children (mean age 11.8 ± 4.2 years, range 3.1 – 18.5 years), and 14 presternal in 13 children (mean age 10.6 ± 5 years, range 0.3 – 17.7 years). The SNPCs were used in special clinical situations such as recurrent ESI with previous abdominal peritoneal catheters, obesity, presence of ureterocutaneostomies, use of diapers, and young age. For the statistical analysis, only the first catheter placed in each child was chosen: 34 standard Tenckhoff catheters and 9 SNPCs.

Intervention

In all children, peritoneal catheters were implanted surgically under general anesthesia by one surgeon; uniform operative technique and perioperative management was used.

Results

The mean observation time for 46 standard Tenckhoff catheters was 23.8 ± 21.1 months, and for 14 SNPCs 25.1 ± 27.0 months. The ESI rate was 1/17.4 patient-months (0.69 episodes/year) for Tenckhoff catheters and 1/70.2 patient-months (0.17 episodes/year) for SNPCs. The observed differences in ESI rates between the groups reported did not achieve statistical significance.

Conclusions

The risk of ESI may be lower with presternal catheters. Confirmation of these findings requires further prospective clinical investigation in large numbers of patients.

Oral Colonization of Staphylococcus Species in a Peritoneal Dialysis Population: A Possible Reservoir for PD-Related Infections?

Peritoneal dialysis-related infections are important morbidity/mortality causes, being staphylococci the most prevalent agents. Since Staphylococcus aureus nasopharynx carriage is a known risk factor for PD infections and the oral cavity is a starting point for systemic diseases development, we aimed at comparing the oral staphylococci colonization between PD patients and controls and studying the association with PD-related infections. Saliva samples were plated in Mannitol salt, and isolates were identified by DnaJ gene sequencing. Staphylococci PD-related infections were recorded throughout the 4-year period following sample collection. Staphylococcus colonization was present in >90% of the samples from both groups (a total of nine species identified). PD patients presented less diversity and less prevalence of multispecies Staphylococcus colonization. Although all patients presenting Staphylococcus epidermidis PD-related infections were also colonized in the oral cavity by the same agent, only 1 out of 7 patients with ESI caused by S. aureus presented S. aureus oral colonization. Staphylococci are highly prevalent in the oral cavity of both groups, although PD patients presented less species diversity. The association between oral Staphylococcus carriage and PD-related infections was present for S. epidermidis but was almost inexistent for S. aureus, so, further studies are still necessary to evaluate the infectious potential of oral Staphylococcus carriage in PD.

Prevention of Catheter Related Infections in Patients on CAPD

Catheter-related infections remain a serious problem for patients on peritoneal dialysis. Such infections can be reduced by careful patient selection and training, by the use of the best connection technology and screening and treating nasal carriage. To date, treatment is less than optimal and therefore, the primary goal should be prevention of catheter-related infections. Prevention is based on improving catheter design and implantation technique, while providing careful exit-site care. Regardless of how it is implemented, we must aggressively pursue the prevention of catheter-related infections by eradicating S.aureus exit-site carriage in PD patients. Based on its effectiveness in adult PD patients, its low rate of adverse effects, and its reasonable cost-effectiveness, application of mupirocin ointment at the exit-site is the current method of choice for preventing PD catheter infections caused byS. aureus. In addition to reducing S. aureus exit-site infections, mupirocin seems to reduce the rates of staphylococcal peritonitis and PD catheter loss. Whether the ointment should be applied in the nares, to the exit-site or both, and whether it should be used only in staphylococcal nasal carriers or all PD patients requires further study.

Bacterial colonization patterns in daily chlorhexidine care at the exit site in peritoneal dialysis patients-A prospective, randomized controlled trial

Bacterial colonization patterns in daily chlorhexidine care at the exit site in peritoneal dialysis (PD) patients were not known. We performed a prospective, randomized controlled trial enrolling 89 PD patients. After stratification by initial Staphylococcus aureus (SA) carrier status, patients were randomly assigned to receive daily 4% chlorhexidine care (intervention group) or normal saline (control group) at the exit site. Monthly, we cultured bacteria from the exit site and nasal swabs for 1 year. The SA colonization rates at exit site at 6 and 12 months were significantly lower in the intervention group than the control group (5.0% vs. 22.9%, p = 0.023 and 8.6% vs. 28.1%, p = 0.037 for 6 and 12 months, respectively). The Methicillin-resistant SA (MRSA) colonization rate at exit site at 6 months was similar (5.7% vs. 2.5%,p = 0.596) in control and intervention group, but significantly lower in the intervention group than the control group at exit site at 12months (0% vs. 12.5%, p = 0.047). The gram-negative bacilli (GNB) colonization rates were similar between the intervention and control groups at 6 and 12 months. Genotyping of all MRSA isolates showed ST (sequence type) 59 was the most predominant clone. In conclusion, chlorhexidine care at the exit site in PD patients may be a good strategy for SA and MRSA decolonization.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02446158.

Peritonitis before Peritoneal Dialysis Training: Analysis of Causative Organisms, Clinical Outcomes, Risk Factors, and Long-Term Consequences

BACKGROUND AND OBJECTIVES

Peritonitis before peritoneal dialysis (PD) training (pretraining peritonitis [PTP]) is an uncommon event. The study aim was to examine the causative organisms, clinical outcomes, risk factors, and long-term consequences of PTP.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

In this single-center, retrospective, observational study involving all incident patients on PD who developed PTP between 1998 and 2012, we examined the causative organisms, primary response rate, complete cure rate, risk factors, and associations of PTP with peritoneal equilibration test (PET) and patient survival. For each patient in the PTP group, the patients who underwent catheter insertion immediately before and after the index case were identified as controls.

RESULTS

Among 1252 incident patients on PD, 52 (4.2%) patients developed PTP, and 104 patients were identified as controls. The two groups were similar in age, sex distribution, comorbidities, and residual renal function, but the PTP group had significantly lower hemoglobin and serum albumin. Patients were followed up for a median of 37.5 months (interquartile range [IQR], 16.3-62.2 months). The most common causative organisms of PTP were Staphylococcus aureus (30.8%) and polymicrobial (21.2%); 25% had negative growth. The primary response and complete cure rates were 82.7% and 78.8%, respectively. In the PTP group, 7.7% of patients died, 9.6% of patients required catheter removal, and PD training was significantly delayed (median =42.0; IQR, 26.0-65.8 days versus 27.5; IQR, 23.0-35.0 days; P=0.01). Multivariate logistic regression analysis showed that serum albumin was the only predictor of PTP (adjusted odds ratio, 0.89 per 1-g/dl increase; 95% confidence interval, 0.82 to 0.97). There were no differences in PET results and dialysis adequacy (measured around 1 month after PD training). The PTP group had significantly worse patient survival (median =41.2; IQR, 21.8-60.5 months versus 55.8; IQR, 40.4-71.2 months; P=0.02). Technique failure occurred in 11.5% and 10.6% of patients in the PTP and control groups, respectively.

CONCLUSIONS

S. aureus is the most common causative organism of PTP. Nutritional interventions in patients who are hypoalbuminemic before catheter insertion deserve additional study.

Prevalence of nasal Staphylococcus aureus carriage in the patients undergoing hemodialysis and evaluation of risk factors and laboratory parameters

BACKGROUND

In this study, we aimed to determine the nasal carriage rate of Staphylococcus aureus and risk factors in hemodialysis (HD) patients.

METHODS

One hundred eighty-four HD patients were evaluated. A second sample was taken from the subjects, the wipe samples of whom were isolated as S. aureus. And subjects whose second samples' results were the same were deemed as S. aureus carriers.

RESULTS

Fifty-two (28.3%) patients were identified as S. aureus carriers. In the control group, S. aureus carriage has been found out as 14.9% in 116 healthy subjects. The isolation rate of S. aureus has been found statistically significantly high in the age group of 41-61 years. But, methicillin-resistant S. aureus (MRSA) isolation ratio has been statistically high in the group over the age of 61 years. Sepsis history and gastrointestinal system disease development is closely related to bacterial isolation. MRSA isolation ratios have been found high in chronic lung disease patients, diabetic patients, patients with infection history, and patients with impaired general state of health. The carriage ratios have been found higher in the patients who are settled in urban areas, are subjected to dialysis for more than 10 years, and are hospitalized in the past year. However, the difference between the other groups is not statistically significant.

CONCLUSIONS

S. aureus carriage must be screened on regular intervals in HD patients. Nasal S. aureus carriage follow-up and treatment is a process that will protect patients from more severe clinical pictures.

Mannose-binding lectin (MBL2) and ficolin-2 (FCN2) polymorphisms in patients on peritoneal dialysis with staphylococcal peritonitis

BACKGROUND

Mannose-binding lectin (MBL) and ficolin-2 (FCN) are activators of the lectin pathway of complement and act as primary defences against infection. Single-nucleotide polymorphisms (SNPs) in the MBL2 and FCN2 genes influence the functionality of the proteins. Both proteins are capable of binding staphylococci, which are pathogens that frequently cause peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). We studied the role of polymorphisms in the MBL2 and FCN2 genes as a risk factor for developing CAPD peritonitis caused by staphylococci.

METHODS

We analysed SNPs in the MBL2 and FCN2 genes in 40 CAPD patients with staphylococcal peritonitis and in 65 CAPD patients without any history of peritonitis. Additionally, we analysed the prevalence of exit site infections and nasal Staphylococcus aureus carriage in both groups.

RESULTS

The + 6359C > T SNP leading to the Thr236Met amino acid alteration in the FCN2 gene, associated with decreased substrate binding, was significantly more prevalent in CAPD patients with a history of staphylococcal peritonitis compared with patients on CAPD without a history of peritonitis (P = 0.037). No difference was found in MBL2 genotypes between the two groups. In CAPD patients with a history of staphylococcal peritonitis, exit site infection with S. aureus was also more prevalent (P < 0.01), while S. aureus carriage was not (P = 0.073).

CONCLUSIONS

In addition to known risk factors such as exit site infection, the + 6359C > T SNP in the FCN2 gene might be a risk factor for staphylococcal peritonitis in CAPD patients due to decreased binding of FCN to staphylococci.

Characteristics of infections in patients undergoing staged implantation for sacral nerve stimulation

OBJECTIVES

To review clinical and surgical factors in patients who have undergone staged sacral nerve stimulator implantation and to determine whether there are any identifiable risk factors for infection.

METHODS

A retrospective chart review was performed on 76 consecutive patients undergoing staged implantation for sacral nerve stimulation for voiding dysfunction. Patients with postprocedural wound infections (after Stage 1 or Stage 2) were compared with those without infections with regard to demographic factors and surgical characteristics, such as operative time and duration of exposed lead wire. Organisms cultured were also documented.

RESULTS

Lead infection occurred in 9 of 76 patients (12%). All cultures grew Staphylococcus aureus. Of 9 patients with lead infection, 6 had organisms sensitive to their perioperative antibiotic. Forty-five patients had an implantable pulse generator implanted, and 5 infections occurred (11%). Four cultures grew S. aureus (all sensitive to the perioperative antibiotic given), whereas one grew Pseudomonas. The only significant difference in clinical/surgical characteristics between infected and noninfected patients was a longer operative time for Stage 2 in infected patients. In addition, 3 patients with infection had one or more known risk factors for wound infection (steroid use, severe psoriasis, recurrent skin abscess).

CONCLUSIONS

Apart from known risk factors for surgical wound infections, the only variable we could identify that might increase the risk for infection is a longer operative time for Stage 2. S. aureus was the organism most commonly cultured. Often it was sensitive to the perioperative antibiotic prophylaxis.

Prevention of peritonitis in children receiving peritoneal dialysis

Peritonitis and catheter-related (exit-site/tunnel) infections are major causes of morbidity in children receiving peritoneal dialysis (PD). Our objective was to evaluate the impact of a combination of prophylactic measures on the rate of peritonitis and catheter-related infections subsequent to their implementation in 2001. This is a single center review of incident patients who received automated peritoneal dialysis (APD) from 1997 to 2004. The causal microorganisms, annualized peritonitis and catheter-related infections rates and the time to infection were reviewed using pooled data from 1997 to 2000 and from 2001 to 2004. Fifty-four patients received PD over 1099 patient months (pm). Twenty-eight peritonitis episodes occurred in 15 patients over 599 pm from 1997 to 2000 (annualized rate (AR): 0.56 infections/patient year). Eight episodes of peritonitis occurred in five patients over 500 pm from 2001 to 2004 (AR: 0.19 infections/patient year) (P = 0.01). Prior to 2001, the median time from dialysis initiation to the first peritonitis episode was 500 days (95% CI, 400-660 days), compared to 1137 days (95% CI, 1050 to +Infinity) from 2001 to 2004 (P = 0.008). The rate of catheter-related infections and time to initial infection during the two periods was not different. We conclude that measures to decrease the frequency of peritonitis can be successfully applied to children and should be incorporated as part of standard care.

Staphylococcus aureusPeritonitis Complicates Peritoneal Dialysis: Review of 245 Consecutive Cases

Peritonitis that is caused by Staphylococcus aureus is a serious complication in peritoneal dialysis (PD), but the clinical course of PD-related S. aureus peritonitis remains unclear. All of the S. aureus peritonitis in a dialysis unit from 1994 to 2005 were reviewed. During this period, 2065 episodes of peritonitis were recorded; 245 (11.9%) episodes in 152 patients were caused by S. aureus and 45 (18.4%) episodes were caused by methicillin-resistant S. aureus (MRSA). Patients with a history of recent hospitalization had a higher risk for isolation of MRSA than the others (30.6 versus 14.2%; P = 0.004). The overall primary response rate was 87.8%; the complete cure rate was 74.3%. However, 21 (8.6%) episodes developed relapse and 59 (24.1%) developed repeat S. aureus peritonitis. Episodes that were caused by MRSA had a lower primary response rate (64.4 versus 93.0%; P < 0.001) and complete cure rate (60.0 versus 77.5%; P = 0.023) than the others. Episodes that were treated initially with vancomycin had better primary response rate than those that were treated with cefazolin (98.0 versus 85.2%; P = 0.001), but the complete cure rate was similar. Adjuvant rifampicin treatment was associated with a significantly lower risk for relapse or repeat S. aureus peritonitis than was treatment without rifampicin (21.4 versus 42.8%; P = 0.004). In contrast, initial antibiotic regimen (cefazolin versus vancomycin) and concomitant exit-site infection did not have any effect on the risk for relapse or repeat peritonitis. S. aureus peritonitis is a serious complication of PD. Recent hospitalization is a major risk factor of methicillin resistance in the bacterial isolate. Rifampicin is a valuable adjunct in preventing relapse and repeat S. aureus peritonitis after the index episode.

Lost in publication: Half of all renal practice evidence is published in non-renal journals

Physicians often scan a select number of journals to keep up to date with practice evidence for patients with kidney conditions. This raises the question of where relevant studies are published. We performed a bibliometric analysis using 195 renal systematic reviews. Each review used a comprehensive method to identify all primary studies for a focused clinical question relevant to patient care. We compiled all the primary studies included in these reviews, and considered where each study was published. Of the 2779 studies, 1351 (49%) were published in the top 20 journals. Predictably, this list included Transplantation Proceedings (5.9% of studies), Kidney International (5.3%), American Journal of Kidney Diseases (4.7%), Nephrology Dialysis Transplantation (4.3%), Transplantation (4.2%), and Journal of the American Society of Nephrology (2.4%). Ten non-renal journals were also on this list, including New England Journal of Medicine (2.4%), Lancet (2.3%), and Diabetes Care (2.2%). The remaining 1428 (51%) studies were published across other 446 journals. When the disciplines of all journals were considered, 59 were classified as renal or transplant journals (42% of articles). Other specialties included general and internal medicine (16%), endocrinology (diabetes) and metabolism (6.5%), surgery (6.2%), cardiovascular diseases (6.1%), pediatrics (4.3%), and radiology (3.3%). About half of all renal practice evidence is published in non-renal journals. Browsing the top journals is important. However, relevant studies are also scattered across a large range of journals that may not be routinely scanned by busy physicians, and keeping up with this literature requires other continuing education strategies.

Oral rifampin for prevention of S. aureus carriage-related infections in patients with renal failure--a meta-analysis of randomized controlled trials

BACKGROUND

Rifampin has been studied as prophylaxis against Staphylococcus aureus-related infections in patients on dialysis.

METHODS

We performed a meta-analysis of randomized controlled trials (RCTs) that compared the effectiveness and safety of oral rifampin with another regimen or no therapy in reducing S. aureus-related infections in dialysis patients.

RESULTS

Four RCTs evaluated oral rifampin (administered for 5 days every 3 months, or for 5 days once) as prophylaxis in dialysis patients. Oral rifampin with or without bacitracin was associated with less access-site infections with S. aureus compared with no treatment (odds ratio = 0.16, 95% confidence intervals: 0.06-0.44, 3 RCTs). There was no difference between prophylaxis with oral rifampin and topical mupirocin applied at the catheter site, for all studied outcomes, in the RCT comparing these regimens. Withdrawal from the study due to drug-related toxicity occurred in 7/107 (6.6%) of the studied patients with renal failure. Development of resistance of S. aureus to rifampin ranged from 0 to 18.2% (reported in three out of four included RCTs).

CONCLUSION

Prophylactic use of oral rifampin reduces access-site infections with S. aureus in patients with renal failure undergoing dialysis. However, development of toxicity and antimicrobial resistance during the treatment with rifampin occur in considerable proportions of patients, limiting its use and supporting the guidelines that recommend the use of local antibiotics at the exit site, such as mupirocin, for these indications. The available data are rather limited and more studies should be performed to examine this important clinical question.

Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: a meta-analysis

A systematic review of the English-language literature was performed to determine the overall benefit of mupirocin therapy in reducing the rate of Staphylococcus aureus infection among patients undergoing hemodialysis (HD) or peritoneal dialysis (PD). Included studies met the following criteria: they were randomized clinical trials or cohort studies; cohorts consisted of adults (age, > or =18 years) requiring HD or PD; mupirocin therapy was administered to the treatment group, and placebo or no therapy was administered to the control group; and the primary outcome of interest was the difference in the number of S. aureus infections among mupirocin-treated and -untreated patients. Ten studies described in 9 articles were analyzed. A total of 2445 patients were included in the analysis. Use of mupirocin reduced the rate of S. aureus infections by 68% (95% confidence interval [CI], 57%-76%) among all patients undergoing dialysis; risk reductions were 80% (95% CI, 65%-89%) among patients undergoing HD and 63% (95% CI, 50%-73%) among patients undergoing PD. When data were stratified by type of infection, S. aureus bacteremia was found to be reduced by 78% among patients undergoing HD, and peritonitis and exit-site infections were found to be reduced by 66% and 62%, respectively, among patients undergoing PD. Mupirocin prophylaxis substantially reduces the rate of S. aureus infection in the dialysis population. Optimal regimens that minimize the emergence of mupirocin resistance need to be explored.

Clinical biodurability of aliphatic polyether based polyurethanes as peritoneal dialysis catheters

Thermoplastic polyurethane elastomers are the most important implantable grade polyurethanes in medical applications. An aliphatic polyether based polyurethane, Tecoflex (TF; Thermedics, Inc., Woburn, MA), is used in the construction of a proprietary peritoneal dialysis (PD) catheter. Information is limited regarding the biostability of the TF polymer in the clinical environment as a PD catheter. This report presents the clinical experience regarding the biodurability of 104 catheter implants. The extracorporeal tubing segments of all TF catheters eventually developed aesthetically offensive discoloration, opaqueness, and surface tackiness. Catheter breaks in the external segment occurred in 27% of devices that survived longer than 28 months. Mupirocin ointment at the catheter skin exit site caused swelling and deformity of the TF in one case. Three catheters extruded as a result of Dacron cuffs separating from the tubing wall. Catheters removed for other reasons were frequently found to have loose cuffs, especially if the devices were implanted for several years. Causes and possible mechanisms for observed failures are discussed. The durability of biomaterials used in construction of PD catheters is of vital importance for successful long-term functioning. The TF polymer embodied as a PD catheter represents a mismatch of the material and its mission. Fabrication of PD catheters from higher grade polyurethanes possessing greater biostability should be explored. Silicone rubber appears to remain the most durable material to date for PD catheter construction.

Nasal Carriage of Staphylococcus aureus As a Risk Factor for Skin and Soft Tissue Infections

Nasal carriage of Staphylococcus aureus is a major risk factor for the development of S. aureus infection, including skin and soft tissue infections and foreign body infections, such as catheter-associated bacteremia and peritonitis. In this article, we review the recent literature on S. aureus nasal carriage, including the emergence of methicillin- resistant S. aureus in the community, the pathophysiology of nasal carriage, and the epidemiology and prevention of S. aureus infections associated with nasal carriage.