Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-30T20:12:41.106Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  26 May 2015

H. M. Gebreselassie ,
T. Kaspar ,
S. Droz  and
J. Marschall
H. M. Gebreselassie
Affiliation:
Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
T. Kaspar
Affiliation:
Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
S. Droz
Affiliation:
Institute for Infectious Diseases, University of Bern, Bern, Switzerland
J. Marschall
Affiliation:
Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To 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.

DESIGN

Screening study and cost-effectiveness analysis.

METHODS

Analysis 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).

RESULTS

There 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).

CONCLUSIONS

In 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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 9 , September 2015 , pp. 1046 - 1049
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. BC Provincial Renal Agency. Approach to managing antibiotic resistant organisms (AROs) in British Columbia hemodialysis units. http://www.bcrenalagency.ca/sites/default/files/documents/files/BCPR-position-paper-AROs-hemodialysis-FINAL.pdf. Updated June 2009.Google Scholar
2. Parker, MG, Doebbeling, BN. The challenge of methicillin-resistant Staphylococcus aureus prevention in hemodialysis therapy. Semin Dial 2012;25:42–49.Google Scholar
3. Kang, YC, Tai, WC, Yu, CC, Kang, JH, Huang, YC. Methicillin-resistant Staphylococcus aureus nasal carriage among patients receiving hemodialysis in Taiwan: prevalence rate, molecular characterization and de-colonization. BMC Infect Dis 2012;12:284.Google Scholar
4. Tacconelli, E, Carmeli, Y, Aizer, A, Ferreira, G, Foreman, MG, D’Agata, EMC. Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: a meta-analysis. Clin Infect Dis 2003;37:1629–1638.Google Scholar
5. Zacharioudakis, IM, Zervou, FN, Ziakas, PD, Mylonakis, E. Meta-analysis of methicillin-resistant Staphylococcus aureus colonization and risk of infection in dialysis patients. J Am Soc Nephrol 2014;25:2131–2141.Google Scholar
6. Lai, CF, Liao, CH, Pai, MF, et al. Nasal carriage of methicillin-resistant Staphylococcus aureus is associated with higher all-cause mortality in hemodialysis patients. Clin J Am Soc Nephrol 2011;6:167–174.Google Scholar
7. Bühlmann, M, Bögli-Stuber, K, Droz, S, Mühlemann, K. Rapid screening for carriage of methicillin-resistant Staphylococcus aureus by PCR and associated costs. J Clin Microbiol 2008;46:2151–2154.Google Scholar
8. Huang, SS, Hinrichsen, VL, Datta, R, et al. Methicillin-resistant Staphylococcus aureus infection and hospitalization in high-risk patients in the year following detection. PLOS ONE 2011;6:e24340.Google Scholar
9. Filice, GA, Nyman, JA, Lexau, C, et al. Excess costs and utilization associated with methicillin resistance for patients with Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2010;31:365–373.Google Scholar
10. Senn, L, Basset, P, Greub, G, et al. Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Switzerland: sampling only invasive isolates does not allow a representative description of the local diversity of clones. Clin Microbiol Infect 2013;19:E288–E290.Google Scholar
11. McCann, M, Moore, ZE. Interventions for preventing infectious complications in haemodialysis patients with central venous catheters. Cochrane Database Syst Rev 2010:CD006894.Google Scholar
12. Lederer, SR, Riedelsdorf, G, Schiffl, H. Nasal carriage of meticillin resistant Staphylococcus aureus: the prevalence, patients at risk and the effect of elimination on outcomes among outclinic haemodialysis patients. Eur J Med Res 2007;127:284–288.Google Scholar
13. Resić, H, Corić, A, Dedeić-Ljubović, A, Hukić, M, Avdić, E, Kukavica, N. Prevalence of MRSA infections in patients on hemodialysis [article in Serbian]. Med Pregl 2007;60:97–100.Google Scholar
14. Dantes, R, Mu, Y, Belflower, R, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med 2013;173:1970–1978.Google Scholar
15. Marschall, J, Mühlemann, K. Duration of methicillin-resistant Staphylococcus aureus carriage, according to risk factors for acquisition. Infect Control Hosp Epidemiol 2006;27:1206–1212.Google Scholar
16. Tübbicke, A, Hübner, C, Hübner, N-O, Wegner, C, Kramer, A, Fleßa, S. Cost comparison of MRSA screening and management—a decision tree analysis. BMC Health Serv Res 2012;12:438.Google Scholar
17. Witteck, A, Rettenmund, G, Schlegel, M. MRSA admission screening in a low prevalence setting—much ado about nothing? Swiss Med Wkly 2011;141:w13217.Google Scholar
18. Price, A, Sarween, N, Gupta, I, Baharani, J. Meticillin-resistant Staphylococcus aureus and meticillin-susceptible Staphylococcus aureus screening in a cohort of haemodialysis patients: carriage, demographics and outcomes. J Hosp Infect 2015;90:22–27.Google Scholar
19. Kohler, P, Bregenzer-Witteck, A, Rettenmund, G, Otterbech, S, Schlegel, M. MRSA decolonization: success rate, risk factors for failure and optimal duration of follow-up. Infection 2013;41:33–40.CrossRefGoogle ScholarPubMed