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Nasal hygiene in patients with end-stage renal disease

Zhao Fan

Dialysis Department of Nephrology Hospital, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R. China

Baiya Li

Dialysis Department of Nephrology Hospital, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P.R. China

Department of Otorhinolaryngology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China

E-mail : lby0929@163.com

DOI: 10.15761/IMM.1000181.

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Abstract

Staphylococcus aureus is the most common endogenous infection in patients with end-stage renal disease (ESRD), and the anterior nares are the most common endogenous S. aureus carrier sites. Eliminating nasal S. aureus will greatly benefit ESRD patients. However, prophylactic topical nasal usage of mupirocin or any kind of antibiotic is against the principles of antibiotic usage. Nasal irrigation has been demonstrated to significantly increase ciliary clearance and decrease mucous inflammation, and has been proven to be an inexpensive, effective, simple, and safe treatment method in nasal health care. We propose that nasal irrigation might be the appropriate nasal hygiene intervention for ESRD patients and should be routinely applied in ESRD patients, especially those with risk factors.

Key words

  ESRD patients, dialysis, nasal S.aureus, nasal irrigation

Introduction

Infection is one of the most common causes of hospitalization, morbidity, and mortality among patients with End-Stage Renal Disease (ESRD) who are undergoing hemodialysis (HD), Peritoneal Dialysis (PD), Continuous Ambulatory Peritoneal Dialysis (CAPD), or kidney transplantations [1-3]. Endogenous gram-positive cocci, especially Staphylococcus aureus (S. aureus), are the most frequently associated microorganism in long-term dialysis patients, and anterior nares are the most common endogenous SA carrier sites [4].

Nasal S. aureus is the most common endogenous infective resource of ESRD patients

Based on sensitivity to methicillin, S. aureus is usually divided into two subclasses, namely methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA). 15.1%-73.9% ESRD patients carried nasal MSSA while 1.1%-27.4% ESRD patients carried MRSA in their noses (Table 1).

Sample Size

Total

S. aureus

MRSA

Dialysis types

Experiment Year

Country

Reference

n

%

n

%

87

20

23.0

-

-

CAPD

1984

UK

[18]

140

63

45.0

-

-

CAPD

1987

Belgium

[19]

146

41

28.1

-

-

CAPD

1989

Singapore

[20]

167

-

-

28

16.8

CAPD

1989

Singapore.

[21]

129

66

51.2

-

-

CAPD

1992

Denmark

[22]

129

60

46.5

-

-

CAPD

1992

Denmark

[22]

168

100

59.5

-

-

HD

1992

Denmark

[22]

168

96

57.1

-

-

HD

1992

Denmark

[22]

172

67

39.0

-

-

HD

1992

Netherland

[6]

54

31

57.4

-

-

CAPD

1993

Netherland

[23]

138

69

50.0

-

-

PD

1993

USA

[24]

32

12

37.5

-

-

CAPD

1995

Denmark

[25]

24

9

37.5

-

-

CAPD

1996

USA

[26]

205

78

38.0

22

10.7

HD

1997

 Saudi Arabia

[15]

28

16

57.1

-

-

HD

1998

 Poland

[27]

52

30

57.7

-

-

PD

1998

Netherland

[28]

144

50

34.7

-

-

HD,CAPD

1999

 UK

[29]

71

39

54.9

-

-

HD

2000

 Spain

[30]

83

-

-

2

2.4

PD

2002

TAIWAN

[31]

198

-

-

11

5.6

HD

2002

USA

[32]

509

-

-

12

2.4

HD

2002

TAIWAN

[31]

69

28

40.6

-

-

HD

2003

Iran

[33]

43

12

27.9

-

-

HD

2004

 Poland

[34]

43

12

27.9

1

2.3

HD

2004

Poland

[35]

136

72

52.9

16

11.8

HD

2004

GERMAN

[4]

261

148

56.7

-

-

HD

2004

Turkey

[36]

289

-

-

34

11.8

HD

2004

Germany

[5]

84

31

36.9

23

27.4

HD

2006

Iran

[37]

157

26

16.6

10

6.4

HD

2006

USA

[38]

103

-

-

12

11.7

HD

2007

USA

[39]

120

40

33.3

26

21.7

DIALYSIS

2007

USA

[17]

130

32

24.6

-

-

HD

2007

 Iran

[40]

306

-

-

29

9.5

HD

2007

TAIWAN

[1]

541

121

22.4

32

5.9

HD

2007

TAIWAN

[16]

54

24

44.4

3

5.6

HD,CAPD

2008

Maroc

[41]

54

24

44.4

3

5.6

HD

2008

Morocco

[41]

46

34

73.9

-

-

TRANSP.

2009

Brazil

[42]

48

36

75.0

-

-

TRANSP.

2009

Brazil

[42]

70

37

52.9

-

-

DIALY.

2009

Brazil

[43]

111

55

49.0

-

-

DIALY.

2009

Brazil

[43]

112

-

-

10

8.9

HD

2009

JAPAN

[44]

264

48

18.2

14

5.3

DIALYSIS

2009

TAIWAN

[2]

70

30

42.9

1

1.4

HD

2010

 Morocco.

[45]

103

-

-

4

3.9

HD

2010

JAPAN

[44]

184

52

28.3

-

-

HD

2011

 Turkey

[46]

296

48

16.2

20

6.8

HD

2011

TAIWAN

[47]

185

28

15.1

2

1.1

HD

2012

 Turkey

[48]

28

16

57.1

-

-

HD

-

Poland

[27]

91

34

37.4

-

-

HD

-

Netherland

[23]

114

34

29.8

-

-

HD

-

Marseille

[50]

Table 1.  Nasal carriage of S. aureus and MRSA in ESRD patients

Nasal S. aureus will spread to the skin and catheter exits via touching, or to the bronchus and lung via airflow. Hence, the nose is the main original source of endogenous S. aureus. Besides, most S. aureus nasal carriers are asymptomatic but have greater potential risk of bacteremia than non-carriers. In particular, dialysis patients who are S. aureus nasal carriers usually have poor clinical outcomes, especially elderly patients [1,2]. Thus, eliminating nasal S. aureus will benefit ESRD patients and reduce the economic burden of both the patients and the government [1,2].

Prophylactic antibiotic is no longer the first choice to eliminate nasal S. aureus

Topical mupirocin application has been proven to be effective in eradicating S. aureus in the nose and catheter exits [5], and has been applied for years [6]. Topical application of mupirocin near catheter exits is rational and necessary because catheterization is an invasive treatment. However, there is no adequate reason for prophylactic nasal application of mupirocin because most S. aureus carriers are asymptomatic. Prophylactic antibiotic usage will induce antibiotic resistance and break the balance of nasal flora between S. aureus and other microorganisms such as Staphylococcus epidermidis. Therefore, prophylactic topical usage of mupirocin or any kind of antibiotic in ESRD patients is against the principles of antibiotic usage. Meanwhile, screening for nasal S. aureus is a time-consuming and economically inefficient process.

Nasal irrigation in patients with end-stage renal disease

Nasal hygiene of ESRD patients is essential but long-ignored. From otolaryngologists’ perspective, we propose that topical nasal irrigation might be the appropriate nasal hygiene intervention for ESRD patients.

Nasal irrigation, also called nasal wash, rinse, douche, and lavage, is a series of adjunctive treatments for patients with chronic sinusitis and a postoperative treatment of other nasal diseases. Abundant data provide evidence that nasal irrigation is an inexpensive, effective, simple, and safe treatment [7-10]. Treatment guidelines in many countries, including China, Europe, and North America, now advocate the use of nasal irrigation for all causes of rhinosinusitis and for postoperative cleaning of the nasal cavities [11].

Nasal irrigation is performed by injecting saline in one nostril and allowing it to drain out of the other nostril, bathing the nasal cavity. In the past century, many trials have been conducted about the irrigating solution components and devices [10]. Currently, a consensus seemed to have been reached that the combination of high-volume and low-pressure devices with hypertonic solutions show optimal outcomes [11,12] . Nasal irrigation has no longer been considered as merely an adjunctive treatment and is now becoming increasingly popular in nasal healthcare [12].

The beneficial mechanisms of nasal irrigation is to increase mucociliary clearance and decrease mucous inflammations, which might include the following aspects: 1) activation of the cilia motility and decreasing the bacterial adhesion, and therefore reducing nasal bacterial attachment; 2) physically flushing away inflammatory mediators, the crust, and other nasal discharges that act as the culture media of bacteria, hence inhibiting bacterial growth [7].

Only low-level evidence support the efficacy of nasal irrigation with antibiotics, suggesting that irrigation itself plays a more important role than the additive antibiotics. Nasal irrigation has been proven to decrease antibiotic usage and thereafter reduce antibiotic resistance [9]. Unfortunately, direct data are lacking that show the elimination effect of nasal irrigation on S. aureus.

Given that it is an inexpensive and convenient procedure, nasal irrigation is recommended to all dialysis patients and health-care staff. Moreover, it should be routinely used among patients with risk factors, which at least include the following: 1) antibiotic usage within 3 months before admission[13]; 2) hospitalization during the past 12 months [13]; 3) diagnosis of skin or soft tissue infection at admission [13,14]; 4) human immunodeficiency virus infection [13]; 5) elderly patient (≥75 years) [1,15]; 6) prolonged hospitalization[1,2]; 7) congestive heart failure [1,2]; and 8) nursing home admission and nasogastric tube feeding in the last 3 months [16,17].

Conflict of interest

 No conflict of interest relevant to this paper is declared.

Disclosure of grants or other funding

 None

References

  1. Lai CF, Liao CH, Pai MF, Chu FY, Hsu SP, et al. (2011) Nasal carriage of methicillin-resistant Staphylococcus aureus is associated with higher all-cause mortality in hemodialysis patients.  Clin J Am Soc Nephrol 6: 167-174. [Crossref]
  2. Wang CY, Wu VC, Chen YM, Su CT, Wu KD, et al. (2010) Risk factors for methicillin-resistant Staphylococcus aureus colonization among elderly patients with end-stage renal disease in Taiwan. Am J Infect Control 386: 499-500. [Crossref]
  3. Hoen B, Paul-Dauphin A, Hestin D, Kessler M (1998) EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients.  J Am Soc Nephrol 9: 869-876. [Crossref]
  4. Lederer SR, Riedelsdorf G, Schiffl H (2007) Nasal carriage of meticillin resistant Staphylococcus aureus: the prevalence, patients at risk and the effect of elimination on outcomes among outclinic haemodialysis patients. Eur J Med Res 127: 284-288. [Crossref]
  5. Schmid H, Romanos A, Schiffl H, Lederer SR (2013) Persistent nasal methicillin-resistant Staphylococcus aureus carriage in hemodialysis outpatients: a predictor of worse outcome. BMC Nephrol 14: 93.
  6. Kluytmans JA, Manders MJ, van Bommel E, Verbrugh H (1996) Elimination of nasal carriage of Staphylococcus aureus in hemodialysis patients.  Infect Control Hosp Epidemiol 17: 793-797. [Crossref]
  7. Papsin B, McTavish A (2003) Saline nasal irrigation: Its role as an adjunct treatment.  Can Fam Physician 49: 168-173. [Crossref]
  8. Rabago D, Zgierska A (2009) Saline nasal irrigation for upper respiratory conditions.  Am Fam Physician 80: 1117-1119. [Crossref]
  9. Adappa ND, Wei CC, Palmer JN (2012) Nasal irrigation with or without drugs: the evidence.  Curr Opin Otolaryngol Head Neck Surg 20: 53-57. [Crossref]
  10. Rudmik L, Soler ZM, Orlandi RR, Stewart MG, Bhattacharyya N, et al. (2011) Early postoperative care following endoscopic sinus surgery: an evidence-based review with recommendations.  Int Forum Allergy Rhinol 1: 417-430. [Crossref]
  11. Dunn JD, Dion GR, McMains KC (2013) Efficacy of nasal irrigations and nebulizations for nasal symptom relief.  Curr Opin Otolaryngol Head Neck Surg 21: 248-251. [Crossref]
  12. Brown CL, Graham SM (2004) Nasal irrigations: good or bad?  Curr Opin Otolaryngol Head Neck Surg 12: 9-13. [Crossref]
  13. Hidron AI, Kourbatova EV, Halvosa JS, Terrell BJ, McDougal LK, et al. (2005) Risk factors for colonization with methicillin-resistant Staphylococcus aureus MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage. Clin Infect Dis 412: 159-66. [Crossref]
  14. 2021 Copyright OAT. All rights reserv
  15. Hoen B, Kessler M, Hestin D, Mayeux D (1995) Risk factors for bacterial infections in chronic haemodialysis adult patients: a multicentre prospective survey.  Nephrol Dial Transplant 10: 377-381. [Crossref]
  16. Saxena AK, Panhotra BR, Chopra R (2004) Advancing age and the risk of nasal carriage of Staphylococcus aureus among patients on long-term hospital-based hemodialysis.  Ann Saudi Med 24: 337-342. [Crossref]
  17. Wang CY, Wu VC, Wang WJ, Chen YM, Su CT, et al. (2009) Nasal carriage of methicillin-resistant Staphylococcus aureus among patients with end-stage renal disease. Infect Control Hosp Epidemiol 301: 93-4. [Crossref]
  18. Wang CY, Wu VC, Wang WJ, Lin YF, Lin YH, et al. (2012) Risk factors for nasal carriage of methicillin-resistant Staphylococcus aureus among patients with end-stage renal disease in Taiwan.  J Formos Med Assoc 111: 14-18. [Crossref]
  19. Davies SJ, Ogg CS, Cameron JS, Poston S, Noble WC (1989) Staphylococcus aureus nasal carriage, exit-site infection and catheter loss in patients treated with continuous ambulatory peritoneal dialysis CAPD).  Perit Dial Int 9: 61-64. [Crossref]
  20. Luzar MA, Coles GA, Faller B, Slingeneyer A, Dah GD, et al. (1990) Staphylococcus aureus nasal carriage and infection in patients on continuous ambulatory peritoneal dialysis.  N Engl J Med 322: 505-509. [Crossref]
  21. Lye WC, Leong SO, van der Straaten J, Lee EJ (1994) Staphylococcus aureus CAPD-related infections are associated with nasal carriage. Adv Perit Dial 10: 163-165. [Crossref]
  22. Lye WC, Leong SO, Lee EJ (1993) Methicillin-resistant Staphylococcus aureus nasal carriage and infections in CAPD.  Kidney Int 43: 1357-1362. [Crossref]
  23. Zimakoff J, Bangsgaard Pedersen F, Bergen L, Baagø-Nielsen J, Daldorph B, et al. (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). J Hosp Infect 334: 289-300. [Crossref]
  24. Wanten GJ, van Oost P, Schneeberger PM, Koolen MI (1996) Nasal carriage and peritonitis by Staphylococcus aureus in patients on continuous ambulatory peritoneal dialysis: a prospective study.  Perit Dial Int 16: 352-356. [Crossref]
  25. Piraino B, Perlmutter JA, Holley JL, Bernardini J (1993) Staphylococcus aureus peritonitis is associated with Staphylococcus aureus nasal carriage in peritoneal dialysis patients.  Perit Dial Int 13: S332-334. [Crossref]
  26. Bistrup C, Jensen KT, Kabel B, Pedersen RS (1997) Staphylococcus aureus carriage in adult peritoneal dialysis patients and their spouses.  Perit Dial Int 17: 480-485. [Crossref]
  27. Mylotte JM, Kahler L, Jackson E (2011) "Pulse" nasal mupirocin maintenance regimen in patients undergoing continuous ambulatory peritoneal dialysis. Infect Control Hosp Epidemiol: 741-745. [Crossref]
  28. Koziol-Montewka M, Chudnicka A, Ksiazek A, Majdan M (2001) Rate of Staphylococcus aureus nasal carriage in immunocompromised patients receiving haemodialysis treatment. Int J Antimicrob Agents 182: 193-6. [Crossref]
  29. Nouwen JL, Fieren MW, Snijders S, Verbrugh HA, van Belkum A 2005) Persistent not intermittent) nasal carriage of Staphylococcus aureus is the determinant of CPD-related infections.  Kidney Int 67: 1084-1092. [Crossref]
  30. Peacock SJ, de Silva GD, Justice A, Cowland A, Moore CE, et al. (2002) Comparison of multilocus sequence typing and pulsed-field gel electrophoresis as tools for typing Staphylococcus aureus isolates in a microepidemiological setting. J Clin Microbiol 4010: 3764-70. [Crossref]
  31. Peña C, Fernández-Sabe N, Domínguez MA, Pujol M, Martinez-Castelao A, et al. (2004) Staphylococcus aureus nasal carriage in patients on haemodialysis: role of cutaneous colonization.  J Hosp Infect 58: 20-27. [Crossref]
  32. Lu PL, Tsai JC, Chiu YW, Chang FY, Chen YW, et al. (2008) Methicillin-resistant Staphylococcus aureus carriage, infection and transmission in dialysis patients, healthcare workers and their family members. Nephrol Dial Transplant 235: 1659-1665. [Crossref]
  33. Hadley AC, Karchmer TB, Russell GB, McBride DG, Freedman BI (2007) The prevalence of resistant bacterial colonization in chronic hemodialysis patients.  Am J Nephrol 27: 352-359. [Crossref]
  34. Ghazvini K, Hekmat R (2007) Nasal and skin colonization of Staphylococcus aureus in hemodialysis patients in Northeast of Iran.  Iran J Kidney Dis 1: 21-24. [Crossref]
  35. Koziol-Montewka M, Szczepanik A, Baranowicz I, Jozwiak L, Ksiazek A. et al. (2006) The investigation of Staphylococcus aureus and coagulase-negative staphylococci nasal carriage among patients undergoing haemodialysis. Microbiol Res 1614: 281-7. [Crossref]
  36. Bogut A, Kozioł-Montewka M, Baranowicz I, Jóźwiak L, Ksiazek A, et al. (2007) Characterisation of Staphylococcus aureus nasal and skin carriage among patients undergoing haemodialysis treatment. New Microbiol 302: 149-54. [Crossref]
  37. Duran N, Ocak S, Eskiocak AF (2006) Staphylococcus aureus nasal carriage among the diabetic and non-diabetic haemodialysis patients.  Int J Clin Pract 60: 1204-1209. [Crossref]
  38. Ghasemian R, Najafi N, Makhlough A, Khademloo M (2010) Frequency of nasal carriage of Staphylococcus aureus and its antimicrobial resistance pattern in patients on hemodialysis.  Iran J Kidney Dis 4: 218-222. [Crossref]
  39. Alexander EL, Morgan DJ, Kesh S, Weisenberg SA, Zaleskas JM, et al. (2011) Prevalence, persistence, and microbiology of Staphylococcus aureus nasal carriage among hemodialysis outpatients at a major New York Hospital. Diagn Microbiol Infect Dis 701: 37-44. [Crossref]
  40. Patel G, Jenkins SG, Mediavilla JR (2011) Clinical and molecular epidemiology of methicillin-resistant Staphylococcus aureus among patients in an ambulatory hemodialysis center. Infect Control Hosp Epidemiol 329: 881-8. [Crossref]
  41. Motamedifar M, Hassanzadeh P, Ghafari N (2010) Relative frequency of Staphylococcal carriage and antibiotic sensitivity of isolated Staphylococci in hemodialysis patients in Shiraz, Iran. Med Princ Pract 195: 379-383. [Crossref]
  42. Souly K, Ait el kadi M, Lahmadi K, Biougnach H, Boughaidi A, et al. (2011) Epidemiology and prevention of Staphylococcus aureus nasal carriage in hemodialyzed patients.  Med Mal Infect 41: 469-474. [Crossref]
  43. Giarola LB, Dos Santos RR, Bedendo J, da Silva Junior WV and Borelli SD (2012) HLA molecules and nasal carriage of Staphylococcus aureus isolated from dialysis and kidney transplant patients at a hospital in Southern Brazil. BMC Res Notes 5: 90. [Crossref]
  44. Giarola LB, Dos Santos RR, Tognim MC, Borelli SD, Bedendo J (2012) Carriage frequency, phenotypic and genotypic characteristics of Staphylococcus aureus isolated from dialysis and kidney tranplant patients at a hosptial in northern parana. Braz J Microbiol 433: 923-30.
  45. Uehara Y, Kuwahara-Arai K, Hori S, Kikuchi K, Yanai M, et al. (2013) Investigation of nasal meticillin-resistant Staphylococcus aureus carriage in a haemodialysis clinic in Japan.  J Hosp Infect 84: 81-84. [Crossref]
  46. Oumokhtar B, Elazhari M, Timinouni M, Bendahhou K, Bennani B, et al. (2013) Staphylococcus aureus nasal carriage in a Moroccan dialysis center and isolates characterization.  Hemodial Int 17: 542-547. [Crossref]
  47. Celik G, Gulcan A, Dikici N, Gulcan E (2011) Prevalence of nasal Staphylococcus aureus carriage in the patients undergoing hemodialysis and evaluation of risk factors and laboratory parameters. Ren Fail 335: 494-498. [Crossref]
  48. Kang YC, Tai WC, Yu CC, Kang JH, Huang YC (2012) Methicillin-resistant Staphylococcus aureus nasal carriage among patients receiving hemodialysis in Taiwan: prevalence rate, molecular characterization and de-colonization. BMC Infect Dis 12: 284.
  49. Aydogan U, Akbulut H, Gok DE, Yilmaz MI, Yuksel S, et al. (2012) To study the correlation between carrier status of nasal Staphylococcus aureus in patients on haemodialysis with hepatitis C, hepatitis B and their sociodemographic features. West Indian Med J 612: 139-44. [Crossref]
  50. Wanten GJ, Schneeberger PM, Bevers A, van Ginneken E, Koolen MI (1998) Optimizing screening procedures for Staphylococcus aureus nasal carriage in patients on haemodialysis.  Nephrol Dial Transplant 13: 1256-1258. [Crossref]
  51. Roubicek C, Brunet P, Mallet MN, Dussol B, Gonzales A, et al. (1995) Nasal carriage of Staphylococcus aureus: prevalence in a hemodialysis center and effect on bacteremia.  Nephrologie 16: 229-232. [Crossref]

Editorial Information

Editor-in-Chief

Masayoshi Yamaguchi
Emory University School of Medicine

Article Type

Short Communication

Publication history

Received date: October 28, 2015
Accepted date: November 17, 2015
Published date: November 20, 2015

Copyright

©2015 Fan Z. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Fan Z, Li B (2015) Nasal hygiene in patients with end-stage renal disease. Integr Mol Med 2: DOI: 10.15761/IMM.1000181.

Corresponding author

Baiya Li

No. 277 Yanta West Road, Xi’an, Shaanxi Province, PR-China, 710061, Tel: 86-177-9182-4589.

E-mail : lby0929@163.com

Sample Size

Total

S. aureus

MRSA

Dialysis types

Experiment Year

Country

Reference

n

%

n

%

87

20

23.0

-

-

CAPD

1984

UK

[18]

140

63

45.0

-

-

CAPD

1987

Belgium

[19]

146

41

28.1

-

-

CAPD

1989

Singapore

[20]

167

-

-

28

16.8

CAPD

1989

Singapore.

[21]

129

66

51.2

-

-

CAPD

1992

Denmark

[22]

129

60

46.5

-

-

CAPD

1992

Denmark

[22]

168

100

59.5

-

-

HD

1992

Denmark

[22]

168

96

57.1

-

-

HD

1992

Denmark

[22]

172

67

39.0

-

-

HD

1992

Netherland

[6]

54

31

57.4

-

-

CAPD

1993

Netherland

[23]

138

69

50.0

-

-

PD

1993

USA

[24]

32

12

37.5

-

-

CAPD

1995

Denmark

[25]

24

9

37.5

-

-

CAPD

1996

USA

[26]

205

78

38.0

22

10.7

HD

1997

 Saudi Arabia

[15]

28

16

57.1

-

-

HD

1998

 Poland

[27]

52

30

57.7

-

-

PD

1998

Netherland

[28]

144

50

34.7

-

-

HD,CAPD

1999

 UK

[29]

71

39

54.9

-

-

HD

2000

 Spain

[30]

83

-

-

2

2.4

PD

2002

TAIWAN

[31]

198

-

-

11

5.6

HD

2002

USA

[32]

509

-

-

12

2.4

HD

2002

TAIWAN

[31]

69

28

40.6

-

-

HD

2003

Iran

[33]

43

12

27.9

-

-

HD

2004

 Poland

[34]

43

12

27.9

1

2.3

HD

2004

Poland

[35]

136

72

52.9

16

11.8

HD

2004

GERMAN

[4]

261

148

56.7

-

-

HD

2004

Turkey

[36]

289

-

-

34

11.8

HD

2004

Germany

[5]

84

31

36.9

23

27.4

HD

2006

Iran

[37]

157

26

16.6

10

6.4

HD

2006

USA

[38]

103

-

-

12

11.7

HD

2007

USA

[39]

120

40

33.3

26

21.7

DIALYSIS

2007

USA

[17]

130

32

24.6

-

-

HD

2007

 Iran

[40]

306

-

-

29

9.5

HD

2007

TAIWAN

[1]

541

121

22.4

32

5.9

HD

2007

TAIWAN

[16]

54

24

44.4

3

5.6

HD,CAPD

2008

Maroc

[41]

54

24

44.4

3

5.6

HD

2008

Morocco

[41]

46

34

73.9

-

-

TRANSP.

2009

Brazil

[42]

48

36

75.0

-

-

TRANSP.

2009

Brazil

[42]

70

37

52.9

-

-

DIALY.

2009

Brazil

[43]

111

55

49.0

-

-

DIALY.

2009

Brazil

[43]

112

-

-

10

8.9

HD

2009

JAPAN

[44]

264

48

18.2

14

5.3

DIALYSIS

2009

TAIWAN

[2]

70

30

42.9

1

1.4

HD

2010

 Morocco.

[45]

103

-

-

4

3.9

HD

2010

JAPAN

[44]

184

52

28.3

-

-

HD

2011

 Turkey

[46]

296

48

16.2

20

6.8

HD

2011

TAIWAN

[47]

185

28

15.1

2

1.1

HD

2012

 Turkey

[48]

28

16

57.1

-

-

HD

-

Poland

[27]

91

34

37.4

-

-

HD

-

Netherland

[23]

114

34

29.8

-

-

HD

-

Marseille

[50]

Table 1.  Nasal carriage of S. aureus and MRSA in ESRD patients