In view of the increasing concern about methicillin-resistant Staphylo
coccus aureus (MRSA) infections, we studied the characteristics and ou
tcome of MRSA nasal carriage and infections in our CAPD program. All p
atients entering into the CAPD program from January 1989 to December 1
991 were enrolled into the study. The patients' anterior nares were cu
ltured before the implantation of the catheters. Peritoneal dialysis-r
elated infections were diagnosed based on standard criteria. Data on M
RSA nasal carriage, exit-site and tunnel infections and peritonitis we
re prospectively collected. A total number of 167 patients with 225.9
patient dialysis years were studied with a mean follow-up duration of
16.2 +/- 9.5 months. There were 28 patients with MRSA nasal carriage.
The carrier state was unrelated to age, sex and presence of diabetes m
ellitus. MRSA nasal carriage was associated with a significant increas
e in the rate of peritonitis (P < 0.01) and exit-site infections (P <
0.01), the number of catheter losses, and CAPD patient dropout (P < 0.
001). A total of 30 patients had MRSA infections. In this group, 15 pa
tients had 24 episodes of peritonitis; 20 had 22 episodes of exit-site
infections; and 1 had tunnel infection. Fourteen patients had a combi
nation and/or multiple episodes of infections. Treatment of MRSA infec
tions with intraperitoneal vancomycin was unsuccessful in 12 patients
(40.0%) resulting in catheter loss. Nine patients (30.0%) dropped out
of CAPD after treatment failure for MRSA peritonitis. The patient drop
out rate per infection for MRSA infections was comparable to Pseudomon
as and fungal infections, but was significantly higher than MSSA infec
tions (P < 0.005). We conclude that MRSA nasal carriage is associated
with an increased risk of CAPD-related infections. MRSA peritonitis is
an important cause of CAPD failure.