血透病人鼻腔金黄色葡萄球菌携带和菌血症发生频率之间的关系

了解慢性肾衰（CRF）病人鼻腔金黄色葡萄球菌（SA）携带率及其与菌血症之间的关系，观察百多邦软膏外用对留置导管血透病人菌血症的预防作用。对2000年11月－2002年4月住院的CRF病人、血透室工作人员、以及CCU病人行鼻拭子培养。留置导管血透病人，每次透析后在导管入口皮肤外涂百多邦作预防治疗，观察菌血症的发生频率。以1999年1月－2000年10月留置导管血透的CRF病人（未做百多邦预防）作为历史对照。结果表明，CRF病人（n=114）鼻拭子培养SA阳性率14％（16／114），同期CCU病人（n=42）和血透室工作人员(n=48）鼻腔SA携带率均为零。血透病人鼻腔SA携带者SA菌血症发生频率0．12次／导管月，非携带者发生频率为零（P＜0．01）。用百多邦预防组（n=70）菌血症发生频率为0．071次／导管月，其中SA菌血症发生频率0．018次／导管月。历史对照组（n=78)菌血症发生频率为0．214次／导管月，其中SA菌血症发生频率0．071次／导管月。两组菌血症及SA菌血症发生频率差异均有显著性意义（P＜0．05）。研究表明，CRF病人鼻腔SA携带率高于正常人和非CRF病人，且与SA菌血症的发生有关；在留置导管口外涂百多邦软膏能有效预防携菌者菌血症的发生。

NASAL CARRIAGE OF STAPES AUREUS IN PATIENTS ON HEMODIALYSIS: RELATIONSHIP WITH INCIDENCE OF THE BACTEREMIA

The study was performed to investigate the prevalence of nasal carriage of Staphylococcus aureus (NCSA) in patients with chronic renal failure(CRF) and its relationship with incidence of bacteremia in patients on hemodialysis(HD). The preventive effect of external application of mupirocin ointment on HD patients with venous catheters was also observed. Nasal swabs were taken from 114 CRF patients hospitalized from Nov. 2000 to April 2002. Samples from 42 patients in CCU with normal renal function and 48 staffs working in HD centre were also analyzed. External application of mupirocin ointment near the exit sites of catheters was performed as prophylaxis in HD patients with venous catheters. The prevalence of SA bacteremia was compared with that of the historical control group from Jan.1999 to Oct.2000. The results showed that the prevalence of NCSA in CRF patients was 14% (16/114). Nasal swab cultures were all negative in CCU patients, as well as staffs working in the HD centre. The mean frequency of SA bacteremia in HD patients with NCSA was 0 12/catheter month, compared to 0 in HD patients with no NCSA( P <0 01). The frequency of bacteremia and SA bacteremia was 0 071 and 0 018/catheter month in mupirocin prophylaxis group( n =70), being much lower than those in historical controls(0 214 and 0 071/catheter month,respectively)( P <0 05). These data suggest that the higher prevalence of NCSA might be correlated with the occurence of SA bacteremia in HD patients with venous catheters. External application of mupirocin ointment can effectively prevent these patients from occurrence of SA bacteremia.