Low Yield of Methicillin-Resistant Staphylococcus aureus Screening in Hemodialysis Patients: 10 Years’ Experience

Abstract

OBJECTIVETo determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in hemodialysis patients and to analyze the cost-effectiveness of our screening approach compared with an alternative strategy.DESIGNScreening study and cost-effectiveness analysis.METHODSAnalysis of twice-yearly MRSA prevalence studies conducted in the hemodialysis unit of a 950-bed tertiary care hospital from January 1, 2004, through December 31, 2013. For this purpose, nasal swab samples were cultured on MRSA screening agar (mannitol-oxacillin biplate).RESULTSThere were 20 mass screenings during the 10-year study period. We identified 415 patients participating in at least 1 screening, with an average of 4.5 screenings per patient. Of 415 screened patients, 15 (3.6%) were found to be MRSA carriers. The first mass screening in 2004 yielded the highest percentage of MRSA (6/101 [6%]). Only 7 subsequent screenings revealed new MRSA carriers, whereas 4 screenings confirmed previously known carriers, and 8 remained negative. None of the carriers developed MRSA bacteremia during the study period. The total cost of our screening approach, that is, screening and isolation costs, was US $93,930. The total cost of an alternative strategy (ie, no mass screening administered) would be equivalent to costs of isolation of index cases and contact tracing was estimated to be US $5,382 (difference, US $88,548).CONCLUSIONSIn an area of low MRSA endemicity (<5%), regular nasal screenings of a high-risk population yielded a low rate of MRSA carriers. Twice-yearly MRSA screening of dialysis patients is unlikely to be cost-effective if MRSA prevalence is low.Infect. Control Hosp. Epidemiol. 2015;36(9):1046–1049

Post-antibiotic era in hemodialysis? Two case reports of simultaneous colonization and bacteremia by multidrug-resistant bacteria

“…Because infections by multidrug-resistant bacteria are associated with a two to five-fold increase in morbidity and mortality compared to infections caused by susceptible isolates, the prevention of both colonization and infection by these microorganisms in patients in hemodialysis is crucial 10 . The screening of multidrug-resistant bacteria becomes more important in endemic countries, because the spread of these microorganisms exceeds the hospital environment and also occurs in outpatient services and in the community 12 . Therefore, prevention strategies should be focused on preventing the transmission of bacteria between patients, health care personnel and medical devices 4 .…”

“…Therefore, prevention strategies should be focused on preventing the transmission of bacteria between patients, health care personnel and medical devices 4 . Because colonization is more frequent than infection and it can persist for long periods of time, the evaluation of prophylactic treatments in colonized patients is necessary to avoid the development of infections, oriented not only to nasal decolonization in the case MRSA, but other body sites, such as the catheter insertion site, where this and other resistant microorganisms can colonize 12 , 13 .…”