Staphylococcus aureus infection in haemodialysis patients. Mupirocin as a topical strategy against nasal carriage: a review

Abstract

Staphylococcus aureus is isolated from 42% of the bacteraemic episodes occurring in haemodialysis patients. Several epidemiological studies indicate that nasal carriage of S. aureus is of pivotal importance in determining the risk of subsequent infections by this micro-organism in haemodialysis patients. First, nasal carriage is prevalent in about 42% of these patients, this high rate being observed from the onset of maintenance dialysis therapy. Second, there is a significant relationship between nasal and hand carriage of the organisms. Third, there is usually a similarity between infecting S. aureus strains and those isolated from nasal surveillance cultures obtained from the same patient. The nares are therefore an elective site for the prevention of S. aureus infections in haemodialysis patients; this was shown with oral rifampin. The studies demonstrating the effectiveness of nasal mupirocin for this indication are summarised. The need for continued chemosuppression with maintenance application (e.g. once per week) is underscored. Such a long-term application of nasal mupirocin in haemodialysis patients with nasal carriage is very cost-effective and is only very rarely associated with the emergence of mupirocin resistance in S. aureus.