Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID)

J Zimakoff, F Bangsgaard Pedersen, L Bergen, J Baagø-Nielsen, B Daldorph, F. Espersen, B Gahrn Hansen, Niels Høiby, O.B. Jepsen, P. Joffe, H J Kolmos, M Klausen, K. Kristoffersen, J Ladefoged, S Olesen-Larsen, V T Rosdahl, J H Scheibel, B Storm, P Tofte-Jensen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

A three-month prospective surveillance study was undertaken in four dialysis centres to establish the prevalence of Staphylococcus aureus carriage in a Danish population of patients on haemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). General data such as sex, age, diagnosis, number of months in dialysis, hospital and ward were registered on a precoded form. Standardized nose and four skin swabs (axillae, groins, perineum) were performed on the first day of the survey. After one and two months, nose swabs were collected. Infections were registered and cultures were sent for phage-typing together with the S. aureus strains isolated from the swabs; 59.5% of HD patients and 51.2% of CAPD patients carried S. aureus. Permanent carriage was most frequent (P < 0.00009), primarily in the nose (44.0 and 34.9%, respectively in HD and CAPD). Skin carriage alone was rare (2.4 and 4.7%). Approximately one third (36.6 and 40.7%) of infections were caused by S. aureus. Although diabetics were not significantly more frequent carriers (60.5%) than non-diabetics (55.0%), the incidence of infection was much higher (26.3% vs. 10.3%, P = 0.004). In CAPD, peritonitis and tunnel/exit-site infections predominated (81.4%), often caused by S. aureus (34.8%). More than two thirds of the infections in HD patients were related to intravascular catheterization. The most serious infection was septicaemia, in all cases due to S. aureus. S aureus infections occurred significantly more frequently among carriers (P = 0.005), and more than half the patients were infected by the same or possibly the same strain as they carried in the nose or on skin. Different regimens for the elimination of S. aureus carriage in dialysis patients are discussed. A policy for risk assessment of patients should be developed, and the elimination of S. aureus carriage before dialysis should be encouraged. Controlled trials comparing the cost-effectiveness of recommended regimens to eliminate carriage in HD/CAPD patients are needed. Nose swabs are reliable indicators of carriage in dialysis patients.

OriginalsprogEngelsk
TidsskriftJournal of Hospital Infection
Vol/bind33
Udgave nummer4
Sider (fra-til)289-300
ISSN0195-6701
StatusUdgivet - aug. 1996

Fingeraftryk

Denmark
Continuous Ambulatory Peritoneal Dialysis
Nose
Skin
Perineum
Groin
Cost-Benefit Analysis
Prospective Studies
Incidence

Citer dette

Zimakoff, J., Bangsgaard Pedersen, F., Bergen, L., Baagø-Nielsen, J., Daldorph, B., Espersen, F., ... Tofte-Jensen, P. (1996). Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID). Journal of Hospital Infection, 33(4), 289-300.
Zimakoff, J ; Bangsgaard Pedersen, F ; Bergen, L ; Baagø-Nielsen, J ; Daldorph, B ; Espersen, F. ; Gahrn Hansen, B ; Høiby, Niels ; Jepsen, O.B. ; Joffe, P. ; Kolmos, H J ; Klausen, M ; Kristoffersen, K. ; Ladefoged, J ; Olesen-Larsen, S ; Rosdahl, V T ; Scheibel, J H ; Storm, B ; Tofte-Jensen, P. / Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID). I: Journal of Hospital Infection. 1996 ; Bind 33, Nr. 4. s. 289-300.
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title = "Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID)",
abstract = "A three-month prospective surveillance study was undertaken in four dialysis centres to establish the prevalence of Staphylococcus aureus carriage in a Danish population of patients on haemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). General data such as sex, age, diagnosis, number of months in dialysis, hospital and ward were registered on a precoded form. Standardized nose and four skin swabs (axillae, groins, perineum) were performed on the first day of the survey. After one and two months, nose swabs were collected. Infections were registered and cultures were sent for phage-typing together with the S. aureus strains isolated from the swabs; 59.5{\%} of HD patients and 51.2{\%} of CAPD patients carried S. aureus. Permanent carriage was most frequent (P < 0.00009), primarily in the nose (44.0 and 34.9{\%}, respectively in HD and CAPD). Skin carriage alone was rare (2.4 and 4.7{\%}). Approximately one third (36.6 and 40.7{\%}) of infections were caused by S. aureus. Although diabetics were not significantly more frequent carriers (60.5{\%}) than non-diabetics (55.0{\%}), the incidence of infection was much higher (26.3{\%} vs. 10.3{\%}, P = 0.004). In CAPD, peritonitis and tunnel/exit-site infections predominated (81.4{\%}), often caused by S. aureus (34.8{\%}). More than two thirds of the infections in HD patients were related to intravascular catheterization. The most serious infection was septicaemia, in all cases due to S. aureus. S aureus infections occurred significantly more frequently among carriers (P = 0.005), and more than half the patients were infected by the same or possibly the same strain as they carried in the nose or on skin. Different regimens for the elimination of S. aureus carriage in dialysis patients are discussed. A policy for risk assessment of patients should be developed, and the elimination of S. aureus carriage before dialysis should be encouraged. Controlled trials comparing the cost-effectiveness of recommended regimens to eliminate carriage in HD/CAPD patients are needed. Nose swabs are reliable indicators of carriage in dialysis patients.",
keywords = "Carrier State, Denmark, Female, Humans, Male, Middle Aged, Nose, Peritoneal Dialysis, Continuous Ambulatory, Prevalence, Prospective Studies, Renal Dialysis, Skin, Staphylococcal Infections, Staphylococcus aureus, Journal Article",
author = "J Zimakoff and {Bangsgaard Pedersen}, F and L Bergen and J Baag{\o}-Nielsen and B Daldorph and F. Espersen and {Gahrn Hansen}, B and Niels H{\o}iby and O.B. Jepsen and P. Joffe and Kolmos, {H J} and M Klausen and K. Kristoffersen and J Ladefoged and S Olesen-Larsen and Rosdahl, {V T} and Scheibel, {J H} and B Storm and P Tofte-Jensen",
year = "1996",
month = "8",
language = "English",
volume = "33",
pages = "289--300",
journal = "Journal of Hospital Infection",
issn = "0195-6701",
publisher = "W.B.Saunders Co. Ltd.",
number = "4",

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Zimakoff, J, Bangsgaard Pedersen, F, Bergen, L, Baagø-Nielsen, J, Daldorph, B, Espersen, F, Gahrn Hansen, B, Høiby, N, Jepsen, OB, Joffe, P, Kolmos, HJ, Klausen, M, Kristoffersen, K, Ladefoged, J, Olesen-Larsen, S, Rosdahl, VT, Scheibel, JH, Storm, B & Tofte-Jensen, P 1996, 'Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID)', Journal of Hospital Infection, bind 33, nr. 4, s. 289-300.

Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID). / Zimakoff, J; Bangsgaard Pedersen, F; Bergen, L; Baagø-Nielsen, J; Daldorph, B; Espersen, F.; Gahrn Hansen, B; Høiby, Niels; Jepsen, O.B.; Joffe, P.; Kolmos, H J; Klausen, M; Kristoffersen, K.; Ladefoged, J; Olesen-Larsen, S; Rosdahl, V T; Scheibel, J H; Storm, B; Tofte-Jensen, P.

I: Journal of Hospital Infection, Bind 33, Nr. 4, 08.1996, s. 289-300.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID)

AU - Zimakoff, J

AU - Bangsgaard Pedersen, F

AU - Bergen, L

AU - Baagø-Nielsen, J

AU - Daldorph, B

AU - Espersen, F.

AU - Gahrn Hansen, B

AU - Høiby, Niels

AU - Jepsen, O.B.

AU - Joffe, P.

AU - Kolmos, H J

AU - Klausen, M

AU - Kristoffersen, K.

AU - Ladefoged, J

AU - Olesen-Larsen, S

AU - Rosdahl, V T

AU - Scheibel, J H

AU - Storm, B

AU - Tofte-Jensen, P

PY - 1996/8

Y1 - 1996/8

N2 - A three-month prospective surveillance study was undertaken in four dialysis centres to establish the prevalence of Staphylococcus aureus carriage in a Danish population of patients on haemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). General data such as sex, age, diagnosis, number of months in dialysis, hospital and ward were registered on a precoded form. Standardized nose and four skin swabs (axillae, groins, perineum) were performed on the first day of the survey. After one and two months, nose swabs were collected. Infections were registered and cultures were sent for phage-typing together with the S. aureus strains isolated from the swabs; 59.5% of HD patients and 51.2% of CAPD patients carried S. aureus. Permanent carriage was most frequent (P < 0.00009), primarily in the nose (44.0 and 34.9%, respectively in HD and CAPD). Skin carriage alone was rare (2.4 and 4.7%). Approximately one third (36.6 and 40.7%) of infections were caused by S. aureus. Although diabetics were not significantly more frequent carriers (60.5%) than non-diabetics (55.0%), the incidence of infection was much higher (26.3% vs. 10.3%, P = 0.004). In CAPD, peritonitis and tunnel/exit-site infections predominated (81.4%), often caused by S. aureus (34.8%). More than two thirds of the infections in HD patients were related to intravascular catheterization. The most serious infection was septicaemia, in all cases due to S. aureus. S aureus infections occurred significantly more frequently among carriers (P = 0.005), and more than half the patients were infected by the same or possibly the same strain as they carried in the nose or on skin. Different regimens for the elimination of S. aureus carriage in dialysis patients are discussed. A policy for risk assessment of patients should be developed, and the elimination of S. aureus carriage before dialysis should be encouraged. Controlled trials comparing the cost-effectiveness of recommended regimens to eliminate carriage in HD/CAPD patients are needed. Nose swabs are reliable indicators of carriage in dialysis patients.

AB - A three-month prospective surveillance study was undertaken in four dialysis centres to establish the prevalence of Staphylococcus aureus carriage in a Danish population of patients on haemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). General data such as sex, age, diagnosis, number of months in dialysis, hospital and ward were registered on a precoded form. Standardized nose and four skin swabs (axillae, groins, perineum) were performed on the first day of the survey. After one and two months, nose swabs were collected. Infections were registered and cultures were sent for phage-typing together with the S. aureus strains isolated from the swabs; 59.5% of HD patients and 51.2% of CAPD patients carried S. aureus. Permanent carriage was most frequent (P < 0.00009), primarily in the nose (44.0 and 34.9%, respectively in HD and CAPD). Skin carriage alone was rare (2.4 and 4.7%). Approximately one third (36.6 and 40.7%) of infections were caused by S. aureus. Although diabetics were not significantly more frequent carriers (60.5%) than non-diabetics (55.0%), the incidence of infection was much higher (26.3% vs. 10.3%, P = 0.004). In CAPD, peritonitis and tunnel/exit-site infections predominated (81.4%), often caused by S. aureus (34.8%). More than two thirds of the infections in HD patients were related to intravascular catheterization. The most serious infection was septicaemia, in all cases due to S. aureus. S aureus infections occurred significantly more frequently among carriers (P = 0.005), and more than half the patients were infected by the same or possibly the same strain as they carried in the nose or on skin. Different regimens for the elimination of S. aureus carriage in dialysis patients are discussed. A policy for risk assessment of patients should be developed, and the elimination of S. aureus carriage before dialysis should be encouraged. Controlled trials comparing the cost-effectiveness of recommended regimens to eliminate carriage in HD/CAPD patients are needed. Nose swabs are reliable indicators of carriage in dialysis patients.

KW - Carrier State

KW - Denmark

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Nose

KW - Peritoneal Dialysis, Continuous Ambulatory

KW - Prevalence

KW - Prospective Studies

KW - Renal Dialysis

KW - Skin

KW - Staphylococcal Infections

KW - Staphylococcus aureus

KW - Journal Article

M3 - Journal article

C2 - 8864941

VL - 33

SP - 289

EP - 300

JO - Journal of Hospital Infection

JF - Journal of Hospital Infection

SN - 0195-6701

IS - 4

ER -