Chronic crusting, nasal carriage of Staphylococcus aureus and relapse rate in pulmonary Wegener's granulomatosis.

Abstract

Wegener's granulomatosis is a systemic disease characterized by necrotizing granulomatous inflammation of the upper and lower respiratory tract and necrotizing crescentic glomerulonephritis. Nasal carriage of S. aureus is considered a risk factor for S. aureus infections. The aim was to examine possible risk factors for relapse including refractory nasal carriage of Staphylococcus aureus in patients with Wegener's granulomatosis. Swab cultures from anterior nares for S. aureus were taken in consecutive patients (n=28), with limited (n=15) and systemic forms (n=13) of biopsy-proven Wegener's granulomatosis. The occurrence of infection and relapses were identified according to defined criteria. Seventeen of the 28 patients (60%: 95% Cl, 41-76%) were found to be chronic nasal carriers of S. aureus (> or =80% of nasal cultures positive for S. aureus). A hazard regression analysis identified chronic nasal carriage of S. aureus as independent risk factor for relapse (HR-4.56; Cl 2.45-7.65) in patients with limited Wegener's granulomatosis. Chronic nasal carriage of S. aureus characterized patients with Wegener's granulomatosis, who are more prone to relapses.