Staphylococcus aureus nasal carriage in 104 cirrhotic and control patients- A prospective study

Background/Aims: Bacterial infections, specially Staphylococcus aureus (S. aureus) septicemia, remain a leading cause of death following liver transpl antation. It has been demonstrated that nasal carriage of S. aureus is asso ciated with invasive infections in patients undergoing hemodialysis and cou ld be decreased by use of antibiotic nasal ointment. However, in cirrhotic patients, the frequency of nasal carriage is unknown. The aims of this stud y were to determine the prevalence of S. aureus nasal carriage in cirrhotic patients and to assess nosocomial contamination. Methods: One hundred and four patients were included in a prospective study , 52 cirrhotic and 52 control (hospitalized patients without cirrhosis or d isease which might increase the rate of nasal carriage of S. aureus). On ad mission and after a few days of hospitalization, nasal specimens from each anterior naris were obtained for culture, S. aureus was identified by the g ram strain, positive catalase and coagulase reactions; antibiotic susceptib ility was determined using a disk-diffusion test. Results: Both groups were similar with regard to age and sex. The prevalenc e of nasal colonization on hospital admission was 56% in cirrhotic patients and 13% in control patients (p=0.001). After an average of 4 days, 42% of cirrhotics and 8% of control patients were colonized (p=0.001), without any nosocomial contamination, Three strains out of 29 were oxacillin-resistant in cirrhotic patients, and none in controls (p>0.05). There was no statist ical difference in carriage rate according to sex, age, cause of cirrhosis and Child-Pugh score. Previous hospitalization (OR, 6.3; 95% CI, 2.3 to 19. 9; p=0.0006) and cirrhosis (OR, 4.4; 95% CI, 1.5 to 13.4; p=0.0048) were in dependent predictors of colonization. Conclusion: Cirrhotic patients had a higher S, aureus nasal carriage rate t han control subjects. Previous hospitalization and cirrhosis diagnosis were correlated to nasal colonization. Further studies are necessary to determi ne if nasal decontamination could reduce S. aureus infections after liver t ransplantation.