A review of Staphylococcus aureus exit-site and tunnel infections in peritoneal dialysis patients.

Staphylococcus aureus peritoneal exit-site and tunnel infections are a source of considerable morbidity for peritoneal dialysis patients. These infections are difficult to resolve, can lead to peritonitis, and often require removal of the peritoneal catheter. Staphylococcal nasal carriage is the major risk factor for S aureus exit-site infections and peritonitis episodes. In the future, the identification of patients who are S aureus nasal carriers and then treatment of the carriage state with rifampin may prove to be a means of decreasing infection rates. The best treatment for S aureus exit-site and tunnel infections has not been established. Treatment regimens in general use include oral antibiotics or intraperitoneal vancomycin. The optimal length of therapy is also unclear. Since the development of the disconnect peritoneal dialysis system, S aureus, rather than the Staphylococcus epidermidis, is the leading cause of peritonitis. To further decrease peritonitis rates, attention must now be directed at catheter-related peritonitis episodes, with S aureus the most common cause of such episodes. Controlled, prospective studies designed to investigate methods of preventing and treating S aureus exit-site infections in peritoneal dialysis patients are needed.