ELIMINATION OF NASAL CARRIAGE OF STAPHYLOCOCCUS-AUREUS IN HEMODIALYSIS-PATIENTS

OBJECTIVE: To study the efficacy of mupirocin for the elimination of n asal carriage of Staphylococcus aureus in hemodialysis patients. DESIG N: The efficacy of mupirocin was studied in a prospectively followed c ohort. The effect of this intervention on the rate of S aureus bactere mia was evaluated using a historic control group. SETTING: Patients on the hemodialysis unit of the University Hospital Rotterdam, a tertiar y 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 tim e 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 Janu ary 1, 1992. RESULTS: The study group consisted of 226 patients, of wh om 172 were evaluated to determine the efficacy of mupirocin. Sixty-se ven (39%) were identified as nasal carriers. Following the initial tre atment, 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 o f episodes of S aureus bacteremia per patient-year on hemodialysis) wa s 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 ef fects were not observed. CONCLUSIONS: Mupirocin nasal ointment effecti vely eliminates nasal carriage of S aureus in patients on hemodialysis . This was associated with a significant reduction of the incidence of S aureus bacteremia, as compared to historic controls.