Chapter 12: Epidemiology of Methicillin Resistant Staphylococcus Aureus Bacteraemia Amongst Patients Receiving Dialysis for Established Renal Failure in England in 2008: a joint report from the UK Renal Registry and the Health Protection Agency

Abstract

Background: From April 2007, all centres providing renal replacement therapy in England were asked to provide additional data on patients with Methicillin Resistant Staphylococcus aureus (MRSA) bacteraemia using a secure web based system established to capture data for the mandatory surveillance of MRSA bacteramia. Results: From April 2008 until March 2009 171 discrete episodes of MRSA bacteraemia were identified from the Health Protection Agency database as being potentially associated with patients in established renal failure (ERF) requiring dialysis. Of 171 records, 18 records were rejected by renal centres as not being associated with patients on dialysis or as being duplicates of other records. Following data validation by centres, 139 patients had vascular access documented (no episodes of bacteraemia were recorded amongst patients receiving peritoneal dialysis). Of these patients, 30.2% were utilising an arteriovenous fistula or graft and 69.8% were dialysing on a nontunnelled or tunnelled venous catheter. Two of the patients on arteriovenous fistulae had used venous catheters in the prior 28 days. Eleven patients had more than one episode in the year and accounted for 30 (20%) of the episodes of MRSA bacteraemia. Overall there was a reduction of 22% in episodes from the previous year. The median centre-specific rate of MRSA bacteraemia was 0.64 (range 0–3.49) episodes per 100 haemodialysis patients per year, and 0.55 (range 0–2.89) episodes per 100 dialysis (haemodialysis and peritoneal dialysis combined) patients per year. Conclusions: The rate of MRSA bacteraemia in patients requiring long term dialysis continues to fall within the prevalent dialysis population in England, but there is still marked variation in centrespecific rates.