Meta-Analysis of Methicillin-Resistant Staphylococcus aureus Colonization and Risk of Infection in Dialysis Patients

Abstract

Patients undergoing dialysis are particularly vulnerable to methicillin-resistant Staphylococcus aureus (MRSA) infections. We performed a meta-analysis of published studies to estimate the prevalence of MRSA colonization in dialysis patients, time trends, and long-term risk of subsequent MRSA infections. Our search of the PubMed and Embase databases returned 5743 nonduplicate citations, from which we identified 38 relevant studies that included data on 5596 dialysis patients. The estimated prevalence of MRSA colonization was 6.2% (95% confidence interval [95% CI], 4.2% to 8.5%). The prevalence increased over time but remained stable after 2000. Stratification of patients according to dialysis modality and setting revealed that 7.2% (95% CI, 4.9% to 9.9%) of patients on hemodialysis were colonized with MRSA compared with 1.3% (95% CI, 0.5% to 2.4%) of patients on peritoneal dialysis (P=0.01), and that a statistically significant difference existed in the percentage of colonized inpatients and outpatients (14.2% [95% CI, 8.0% to 21.8%] versus 5.4% [95% CI, 3.5% to 7.7%], respectively; P=0.04). Notably, the risk of developing MRSA infections increased among colonized hemodialysis patients compared with noncolonized patients (relative risk, 11.5 [95% CI, 4.7 to 28.0]). The longterm (6-20 months) probability of developing a MRSA infection was 19% among colonized hemodialysis patients compared with only 2% among noncolonized patients. In summary, 6.2% of dialysis patients are MRSA colonized, and the average prevalence of colonization has remained stable since 2000. Colonization in hemodialysis patients is associated with increased risk of MRSA infection.

MRSA and VRE Colonization in Solid Organ Transplantation: A Meta-Analysis of Published Studies

“…One first finding from this study is the high prevalence of MRSA and VRE colonization even before transplantation. The observed prevalence of MRSA colonization in the transplant setting is comparable with the estimated MRSA carriage of other high-risk populations, such as patients on hemodialysis (7.2%, 95% CI 4.9%-9.9%) (39) and patients admitted to the ICU (7.0%, 95% CI 5.8%-8.3%) (4). The risk of VRE colonization also shows similarity to that observed in the ICU setting (8.8%, 95% CI 7.1%-10.6%) (5).…”

Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis

“…However, there are important ways in which home HD differs from in-center HD that may substantially alter the risks associated with CVC use. Patients undergoing in-center HD have three times per week exposure to dialysis facilities, in which they come into contact with other chronically ill patients as well as facility staff members, presenting opportunities for exposure to exogenous organisms, including multidrug-resistant organisms (23)(24)(25). Although rates of colonization with multidrugresistant organisms are unknown in patients undergoing home HD, it is plausible that less frequent contact with health care facilities would result in less frequent colonization and infection.…”

What Is the Significance of <b><i>Staphylococcus aureus </i></b>Colonization in Hemodialysis Patients?

“…MRSA colonization in hemodialysis patients has been associated with a higher subsequent risk of infection and bacteremia [8] and a 2.46-fold higher risk of all-cause mortality [9]. Patel et al reported that 17.6% of patients colonized with MRSA subsequently developed a clinical infection [3].…”

“…Patel et al reported that 17.6% of patients colonized with MRSA subsequently developed a clinical infection [3]. Likewise, a recent meta-analysis reported that 19% of hemodialysis patients with MRSA colonization developed a clinical MRSA infection within 6-20 months [8]. …”