STAPHYLOCOCCUS-AUREUS CARRIAGE AND INFECTIONS AMONG PATIENTS IN 4 HAEMO-DIALYSIS AND PERITONEAL-DIALYSIS CENTERS IN DENMARK

A three-month prospective surveillance study was undertaken in four di alysis centres to establish the prevalence of Staphylococcus aureus ca rriage in a Danish population of patients on haemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). General data such as sex, age, diagnosis, number of months in dialysis, hospital and ward were registered on a preceded form. Standardized nose and four skin sw abs (axillae, grains, perineum) were performed on the first day of the survey. After one and two months, nose swabs were collected. Infectio ns were registered and cultures were sent for phage-typing together wi th the S. aureus strains isolated from the swabs; 59.5% of HD patients and 51.2% of CAPD patients carried S. aureus. Permanent carriage was most frequent (P < 0.00009), primarily in the nose (44.0 and 34.9%, re spectively in HD and CAPD). Skin carriage alone was rare (2.4 and 4.7% ). Approximately one third (36.6 and 40.7%) of infections were caused by S. aureus. Although diabetics were not significantly more frequent carriers (60.5%) than nondiabetics (55.0%), the incidence of infection was much higher (26.3% vs. 10.3%, P = 0.004). In CAPD, peritonitis an d tunnel/exit-site infections predominated (81.4%), often caused by S. aureus (34.8%). More than two third of the infections in HD patients were related to intravascular catheterization. The most serious infect ion was septicaemia, in all cases due to S. aureus. S. aureus infectio ns occurred significantly more frequently among carriers (P = 0.005), and more than half the patients were infected by the same or possibly the same strain as they carried in the nose or on skin. Different regi mens for the elimination of S. aureus carriage in dialysis patients ar e discussed. A policy for risk assessment of patients should be develo ped, and the elimination of S. aureus carriage before dialysis should be encouraged. Controlled trials comparing the cost-effectiveness of r ecommended regimens to eliminate carriage in HD/CAPD patients are need ed. Nose swabs are reliable indicators of carriage in dialysis patient s.