Abstract
Background/Aims: Bacterial infections, specially Staphylococcus aureus (S. aureus) septicemia, remain a leading cause of death following liver transplantation. It has
been demonstrated that nasal carriage of S. aureus is associated with invasive infections in patients undergoing hemodialysis and could
be decreased by use of antibiotic nasal ointment. However, in cirrhotic patients,
the frequency of nasal carriage is unknown. The aims of this study were to determine
the prevalence of S. aureus nasal carriage in cirrhotic patients and to assess nosocomial contamination.
Methods: One hundred and four patients were included in a prospective study, 52 cirrhotic
and 52 control (hospitalized patients without cirrhosis or disease which might increase
the rate of nasal carriage of S. aureus). On admission and after a few days of hospitalization, nasal specimens from each
anterior naris were obtained for culture. S. aureus was identified by the gram strain, positive catalase and coagulase reactions; antibiotic
susceptibility was determined using a disk-diffusion test.
Results: Both groups were similar with regard to age and sex. The prevalence of nasal colonization
on hospital admission was 56% in cirrhotic patients and 13% in control patients (p=0.001). After an average of 4 days, 42% of cirrhotics and 8% of control patients
were colonized (p=0.001), without any nosocomial contamination. Three strains out of 29 were oxacillin-resistant
in cirrhotic patients, and none in controls (p>0.05). There was no statistical difference in carriage rate according to sex, age,
cause of cirrhosis and Child-Pugh score. Previous hospitalization (OR, 6.3; 95% CI,
2.3 to 19.9; p=0.0006) and cirrhosis (OR, 4.4; 95% CI, 1.5 to 13.4; p=0.0048) were independent predictors of colonization.
Conclusion: Cirrhotic patients had a higher S. aureus nasal carriage rate than control subjects. Previous hospitalization and cirrhosis
diagnosis were correlated to nasal colonization. Further studies are necessary to
determine if nasal decontamination could reduce S. aureus infections after liver transplantation.
Keywords
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Article info
Publication history
Accepted:
September 8,
1998
Received in revised form:
September 1,
1998
Received:
February 23,
1998
Identification
Copyright
© 1999 Published by Elsevier Inc.
