Staphylococcus aureus nasal carriage in hemodialysis patients. Its role in infection and approaches to prophylaxis.

Staphylococcus aureus infections remain a major cause of morbidity in hemodialysis patients. Chronic dialysis patients are more prone to staphylococcal infections because of their decreased immunity, increased skin colonization by staphylococci, and the multiple needle punctures required for dialysis. The source of the staphylococci is the anterior nares. Elimination of staphylococcal nasal carriage results in a significantly lower infection rate. Selected clinical studies of topical and oral therapy for eradication of staphylococcal nasal carriage are reviewed. Rifampin has been the most consistently efficacious agent, although emergence of resistance is a potential problem. Trials utilizing newer topical and oral agents for prophylactic eradication of S aureus from the nose are indicated. Promising antibiotics include topical mupirocin, the oral quinolones, and clindamycin.