Association of chronic nasal carriage of Staphylococcus aureus and higher relapse rates in Wegener granulomatosis

Ann Intern Med. 1994 Jan 1;120(1):12-7. doi: 10.7326/0003-4819-120-1-199401010-00003.


Objective: To examine possible risk factors for relapse, including chronic nasal carriage of Staphylococcus aureus and serial antineutrophil cytoplasmic antibody (ANCA) determinations in patients with Wegener granulomatosis.

Design: Observational cohort study.

Setting: Outpatient clinic at a university-affiliated hospital.

Patients: Consecutive patients (n = 71) with biopsy-proven Wegener granulomatosis who were seen during follow-up at the outpatient clinic from January 1988 to July 1991. Fourteen patients were ineligible or dropped out; 57 patients were analyzed.

Measurements: Serial ANCA determinations and swab cultures of both anterior nares for S. aureus taken at each visit every 4 to 6 weeks. Occurrence of infections and relapses of Wegener granulomatosis were identified according to strict, predefined criteria.

Results: Thirty-six of the 57 patients (63%; 95% CI, 49% to 76%) were found to be chronic nasal carriers of S. aureus (> or = 75% of nasal cultures positive for S. aureus). Proportional-hazards regression analysis identified chronic nasal carriage of S. aureus (adjusted relative risk, 7.16; CI, 1.63 to 31.50), creatinine clearance above 60 mL.min-1 (adjusted relative risk, 2.94; CI, 1.27 to 6.67), and a history of previous relapses of Wegener granulomatosis (adjusted relative risk, 1.33; CI, 0.98 to 1.78) as independent risk factors for relapse. Twenty-two of 33 patients persistently or intermittently positive for ANCA had a relapse as opposed to only 1 of 21 persistently negative patients. Relapses of Wegener granulomatosis were not related to diagnosed infections.

Conclusion: Chronic nasal carriage of S. aureus identifies a subgroup of patients with Wegener granulomatosis who are more prone to relapses of the disease, suggesting a role for S. aureus in its pathophysiology and a possible clue for treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies, Antineutrophil Cytoplasmic
  • Autoantibodies / blood
  • Biomarkers / blood
  • Carrier State*
  • Chronic Disease
  • Cohort Studies
  • Female
  • Granulomatosis with Polyangiitis / complications*
  • Granulomatosis with Polyangiitis / immunology
  • Humans
  • Male
  • Middle Aged
  • Nose / microbiology*
  • Proportional Hazards Models
  • Recurrence
  • Risk Factors
  • Staphylococcal Infections / complications*
  • Staphylococcal Infections / immunology


  • Antibodies, Antineutrophil Cytoplasmic
  • Autoantibodies
  • Biomarkers