Summary auto-generated
This study investigated the epidemiology of peritonitis caused by coagulase-negative staphylococci in continuous ambulatory peritoneal dialysis (CAPD) patients. Researchers prospectively collected skin swabs from 55 CAPD patients over 12 months and analyzed 10 episodes of peritonitis in six patients using a highly discriminatory typing scheme combining antibiograms, biochemical profiles, phage typing, and plasmid analysis. The infecting organism was recovered from skin swabs before peritonitis onset in 60% of episodes, always appearing within 2 weeks prior but never more than 12 weeks earlier, suggesting recent acquisition. When recovered, infecting strains were widely distributed across multiple body sites (axillae, umbilicus, connector) as predominant organisms. Notably, infecting strains did not differ significantly from non-infecting strains in adherence or slime production, contrary to previous claims. The widespread, unpredictable distribution of organisms on skin would make prevention through targeted skin decolonization difficult, unlike the successful approach used for Staphylococcus aureus.
Key findings
- Infecting coagulase-negative staphylococcal strains were identified on prospective skin swabs in 6 of 10 peritonitis episodes, always within 2 weeks before infection but never beyond 12 weeks prior
- Organisms showed widespread distribution across multiple body sites when found on skin, making targeted decolonization strategies impractical
- Infecting strains were no more likely to be adherent or produce slime than non-infecting skin strains (12% vs 25% for adherence, p=0.3)
- Most infecting strains were Staphylococcus epidermidis with evidence of plasmid loss during infection in some cases
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Abstract
The epidemiology of 10 episodes of CAPD peritonitis caused by coagulase-negative staphylococci was studied. The infecting micro-organism was found in prospective skin swabs in six episodes, widely distributed and as the predominant, or equally predominant, organism at each site but was not detected in swabs taken more than 12 weeks before the episode of peritonitis; this suggests recent acquisition. Infecting strains were no more likely to be adherent or to produce slime than non-infecting strains, nor had they any other characteristic detected in our typing scheme that might lead to their detection before peritonitis developed.