Elimination of Nasal Carriage of Staphylococcus aureus in Hemodialysis Patients

OBJECTIVE: To study the efficacy of mupirocin for the elimination of nasal carriage of Staphylococcus aureus in hemodialysis patients. DESIGN: The efficacy of mupirocin was studied in a prospectively followed cohort. The effect of this intervention on the rate of S aureus bacteremia was evaluated using a historic control group. SETTING: Patients on the hemodialysis unit of the University Hospital Rotterdam, a tertiary 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 time 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 January 1, 1992. RESULTS: The study group consisted of 226 patients, of whom 172 were evaluated to determine the efficacy of mupirocin. Sixty-seven (39%) were identified as nasal carriers. Following the initial treatment, 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 of episodes of S aureus bacteremia per patient-year on hemodialysis) was 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 effects were not observed. CONCLUSIONS: Mupirocin nasal ointment effectively 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.