Staphylococcal peritonitis in continuous ambulatory peritoneal dialysis: Colonization with identical strains at exit site, nose, and hands

To evaluate the relationship of nasal or skin Staphylococcus carrier status with identical strains and the development of staphylococcal peritonitis, 59 consecutive peritonitis episodes in patients using a twin-bag system for continuous ambulatory peritoneal dialysis from a single dialysis center we re prospectively studied. Dialysate samples and exit-site, nose, and nail s wabs from patients and their dialysis partners were obtained on the same da y for culture. When bacteria belonging to the same species of the Staphyloc occus genus were isolated from dialysate and at least one extraperitoneal a natomic site, pulsed-field gel electrophoresis typing was performed. The ba cterial strains isolated from catheter exit site, nose, or nails of each pa tient and his or her dialysis partner were classified as identical or diffe rent, Twenty-seven of the 59 peritonitis episodes (46%) were caused by stap hylococci. Nineteen of these 27 patients carried the same Staphylococcus sp ecies causing the peritonitis episode at the exit site, nose, or nails, but only 17 patients (63%) carried an identical strain. Four of 5 dialysis par tners carried the same Staphylococcus species causing the peritonitis episo de at nose or nails, but the strain was identical for only 3 dialysis partn ers (60%). Four patients and 1 dialysis partner carried unrelated strains o f the Staphylococcus species causing the peritonitis episode. The most freq uently colonized site with strains identical to that causing the peritoniti s episode was the catheter exit site, followed by nose and nails. This find ing may be clinically relevant because eradication of Staphylococcus aureus colonizing the catheter exit site may be more important and have a greater likelihood of success than maneuvers directed to more distant locations. ( C) 2001 by the National Kidney Foundation, Inc.