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Elimination of Nasal Carriage of Staphylococcus aureus in Hemodialysis Patients

Published online by Cambridge University Press:  02 January 2015

Jan A.J.W. Kluytmans ,
Marie-Jose Manders ,
Erik van Bommel  and
Henri Verbrugh
Jan A.J.W. Kluytmans*
Affiliation:
Department of Clinical Microbiology, and the Department of Nephrology, University Hospital Rotterdam, The Netherlands
Marie-Jose Manders
Affiliation:
Department of Clinical Microbiology, and the Department of Nephrology, University Hospital Rotterdam, The Netherlands
Erik van Bommel
Affiliation:
Department of Clinical Microbiology, and the Department of Nephrology, University Hospital Rotterdam, The Netherlands
Henri Verbrugh
Affiliation:
Department of Clinical Microbiology, and the Department of Nephrology, University Hospital Rotterdam, The Netherlands
*
Department of Clinical Microbiology, Ignatius Hospital, PO Box 90158, 4800 RK Breda, The Netherlands
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Abstract

Objective:

To study the efficacy of mupirocin for the elimination of nasal carriage of Staphylococcus aureus in hemodialysis patients.

Design:

The efficacy of mupirocin was studied in a prospectively followed cohort. The effect of this intervention on the rate of S aureus bacteremia was evaluated using a historic control group.

Setting:

Patients on the hemodialysis unit of the University Hospital Rotterdam, a tertiary referral center.

Patients:

The study group consisted of consecutive patients on hemodialysis from February 1, 1992, until November 1, 1993. They were screened by taking nasal cultures monthly during their time on hemodialysis. If S aureus was isolated, treatment with mupirocin nasal ointment was initiated. The control group consisted of patients treated on the same hemodialysis unit from January 1, 1990, until January 1, 1992.

Results:

The study group consisted of 226 patients, of whom 172 were evaluated to determine the efficacy of mupirocin. Sixty-seven (39%) were identified as nasal carriers. Following the initial treatment, 66 nasal cultures (98.5%) became negative. After 3 months and 6 months, respectively, 63 (94%) and 61 (91%) of the treated carriers had negative cultures. The rate of bacteremia (defined as the number of episodes of 5 aureus bacteremia per patient-year on hemodialysis) was significantly lower among the 226 patients in the study group (0.04 per patient-year) than among the 273 patients in the control group (0.25 per patient year; P <.001). Development of resistance and adverse effects were not observed.

Conclusions:

Mupirocin nasal ointment effectively eliminates nasal carriage of 5 aureus in patients on hemodialysis. This was associated with a significant reduction of the incidence of 5 aureus bacteremia, as compared to historic controls.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 12 , December 1996 , pp. 793 - 797
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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