Comparison of the bacterial flora of the nasal vestibule and cavity in haemodialysis patients

Staphylococcal infections are the major causes of morbidity in haemodialysis patients. The source of the staphylococci is the anterior nares. Elimination of nasal carriage of staphylococci could result in a remarkable decrease in the infection rate. The aim of this study was to investigate if there was a difference in the bacterial flora between the nasal vestibule and cavity as well as their antibiotic susceptibility in haemodialysis. Swab samples obtained from 35 haemodialysis patients were subjected to conventional microbiological methods. The antimicrobial susceptibility test was performed for Staphylococcus spp. using cephazolin, cephaclor, trimetoprim + sulfamethoxazole, amoxicillin, oxacillin, clindamycin, erythromycin, tetracycline, ampicillin + sulbactam and amoxicillin + clavulanic acid. Staphylococcus spp. was found more often in the vestibule than in the cavity (88.5 vs. 77.1%). The effectiveness of clindamycin, erythromycin and tetracycline was particularly striking for the methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococci isolates. In conclusion, existence of difference in bacterial flora between the nasal cavity and vestibule and their responsiveness to antibacterial agents may require reconsideration of elimination of secondary infections in haemodialysis patients.