Abstract
BackgroundStaphylococcus aureus, particularly methicillin resistant (MRSA), is a common pathogen among patients receiving hemodialysis. To evaluate nasal carriage, molecular characterization and effectiveness of decolonization of MRSA among patients receiving hemodialysis in Taiwan, we conducted this study.MethodsFrom January to June 2011, two nasal samplings with a 3-month interval were obtained from patients undergoing hemodialysis in a medical center (CGMH), and in a local hospital (YMH) and sent for detection of MRSA. For MRSA carriers, decolonization procedures were administered. All patients in CGMH were observed if MRSA infections occurred during the study period.ResultsA total of 529 nasal specimens (265 from CGMH and 264 from YMH) were collected from 296 patients (161 from CGMH and 135 from YMH). 233 patients participated in both surveys. Average one-time point MRSA carriage rate was 3.8%, and the rate was up to 6.9% for those with two-time point surveys. No additional significant factor for MRSA carriage was identified. Seventy percent of the 20 colonizing MRSA isolates, though categorized as healthcare-associated strains epidemiologically, shared common molecular characteristics of the local community-associated strains. Only one of the 20 MRSA-colonized patients failed decolonization and had persistent colonization, while without any intervention, 17 (61%) of 28 patients with methicillin-sensitive S. aureus colonization in the first survey had persistent colonization of a genetically indistinguishable strain. Within the study period, two patients (1.24%) in CGMH, one with MRSA colonization (9.1%), developed MRSA infection.ConclusionA substantial proportion of patients receiving hemodialysis in Taiwan had MRSA colonization, mostly genetically community strains. Decolonization procedures may effectively eliminate MRSA colonization and might reduce subsequent MRSA infection in these patients.
Highlights
Staphylococcus aureus, methicillin resistant (MRSA), is a common pathogen among patients receiving hemodialysis
104 subjects in Chang Gung Memorial Hospital (CGMH) and 129 subjects in Yang Ming Hospital (YMH) participated in both surveys. 116 patients in CGMH participated in the first survey, among whom 12 patients withdrew for the second survey, while additional 45 patients participated in the second survey. 129 patients in YMH participated in both surveys, and additional 6 patients participated in the second survey
The carriage rates for the patients receiving both surveys were similar by batch survey but the rate of Methicillin-sensitive Staphylococcus aureus (MSSA) and MRSA carriage was up to 15.9% and 6.9%, respectively, if either specimen from each subject was positive (Table 1)
Summary
Staphylococcus aureus, methicillin resistant (MRSA), is a common pathogen among patients receiving hemodialysis. Molecular characterization and effectiveness of decolonization of MRSA among patients receiving hemodialysis in Taiwan, we conducted this study. Among patients with end-stage renal disease (ESRD), bacterial infections are the major cause of morbidity and mortality during receiving hemodialysis [5] and Staphylococcus aureus, methicillin-resistant, is one of the most common pathogens [6,7]. Since colonization of S. aureus usually precedes clinical infection [10,11], we wondered if the patients receiving hemodialysis have a higher rate of MRSA carriage. We conducted a study to evaluate the carriage rate of MRSA, molecular characterization of these MRSA isolates as well as the effectiveness of decolonization procedures among the patients receiving hemodialysis in both a medical center and a local hospital in Taiwan
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