Methicillin‐resistant Staphylococcus aureus carriage in hospitalized chronic hemodialysis patients and its predisposing factors

Abstract

There has been a paucity of literature on methicillin-resistant Staphylococcus aureus (MRSA) colonization in chronic hemodialysis patients who required admission. The purpose of this study is to determine the MRSA carriage rate in hospitalized chronic hemodialysis patients, to identify the risk factors, and assess the consequences of MRSA colonization. This was a retrospective study of hospitalized chronic hemodialysis patients at Khoo Teck Puat Hospital from July 1, 2010 to June 30, 2011. MRSA screening was done on the day of admission using culture method with MRSA select (Bio-Rad)™. The patients were divided into two groups: MRSA carriers and noncarriers. Demographic data, medical, and laboratory information was obtained via electronic medical record system. Outcome measures were infection rates during current hospitalization episode, frequency of hospitalization, and cumulative hospitalization days per year. Prevalence rate of MRSA colonization in hospitalized chronic hemodialysis patients was 15.1%, compared to all admitted patients (5.8%). Diabetes mellitus, Malay ethnicity, shorter hemodialysis duration and use of tunneled hemodialysis catheters were associated with MRSA colonization (P < 0.05). Relative risk of infection during the episode of admission among MRSA carriers was 3.2-fold compared to noncarriers. MRSA colonization rates tend to be higher in patients on hemodialysis for less than 3 years and it correlates with longer hospitalization after adjustment for other variables (P < 0.05). Patients on chronic hemodialysis requiring admission have higher rates of MRSA colonization. The risk factors of MRSA carriers and the correlation of MRSA rates to longer hospitalization suggest its nosocomial origin in this group of patients.

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

“…28,30,33,42,43,46 Two of these studies reported the MRSA infection rate during hospitalization of inpatient individuals, 33,43 whereas four studies included data after a long-term follow-up period of outpatient individuals. 28,30,42,46 Because we were interested in the long-term risk of acquiring a MRSA infection, only the data from the latter four studies were used and the data from each study are summarized in Table 3.…”

Risk factors for meticillin-resistant Staphylococcus aureus colonization in dialysis patients: a meta-analysis

“…10,12,13,15 Difference in length of time on haemodialysis among colonized and noncolonized dialysis patients was assessed through three studies, but no statistically significant trend was found (P ¼ 0.934). 10,12,16 Finally, the gender (RR: 0.97, male; 95% CI: 0.53e1.81; Q ¼ 9.06; P for heterogeneity ¼ 0.06) (Supplementary Figure S8) did not display significant association with colonization. 8,10,12,16 A smaller number of studies provided some additional findings.…”

“…10,12,16 Finally, the gender (RR: 0.97, male; 95% CI: 0.53e1.81; Q ¼ 9.06; P for heterogeneity ¼ 0.06) (Supplementary Figure S8) did not display significant association with colonization. 8,10,12,16 A smaller number of studies provided some additional findings. Two studies, with 300 patients total, provided data on history with MRSA colonization or infection and our analysis indicated that patients with previous history of colonization or infection were more likely to be colonized with this same pathogen (RR: 7.61; 95% CI: 3.43e14.98; Q ¼ 0.35; P for heterogeneity ¼ 0.554).…”

“…10,12,13,15,16 We found that patients with catheters had 66.2% increased probability of being colonized with MRSA [relative risk (RR): 1.66; 95% CI: 1.06e2.60; P for heterogeneity ¼ 0.612], compared to patients who carried permanent dialysis access (Table II, Supplementary Figure S2). There was no evidence of publication bias in this estimation (Egger's test, À0.399; P ¼ 0.834).…”

“…However, these patients can be easily identified and infection control protocols can target this subgroup with screening, isolation and, possibly, decolonization policies. Also, the finding that previous history of MRSA Kang et al 10 1/22 (4.5%) 18/278 (6.4%) Lai et al 12 2/18 (11.1%) 27/288 (9.3%) Patel et al 13 4/23 (17.4%) 8/80 (10.0%) Schmid et al 15 29/240 (12.1%) 5/49 (10.2%) Yeoh et al 16 13/50 (26%) 14 colonization or infection was associated with MRSA colonization, although it is not surprising, it is another indication that decolonization protocols should be intensified. The association of temporary catheters with the risk of MRSA colonization consorts well with the established clinical practice that supports the use of permanent access (i.e.…”