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Clinical and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus among Patients in an Ambulatory Hemodialysis Center

Published online by Cambridge University Press:  02 January 2015

Gopi Patel ,
Stephen G. Jenkins ,
José R. Mediavilla ,
Barry N. Kreiswirth ,
Brian Radbill ,
Cassandra D. Salgado  and
David P. Calfee
Gopi Patel
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York
Stephen G. Jenkins
Affiliation:
Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
José R. Mediavilla
Affiliation:
Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
Barry N. Kreiswirth
Affiliation:
Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
Brian Radbill
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York
Cassandra D. Salgado
Affiliation:
Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
David P. Calfee
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York Departments of Medicine and Public Health, Weill Cornell Medical College, New York, New York
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Abstract

Objective.

To describe the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) carriage and transmission in an ambulatory hemodialysis population.

Design.

Prospective cohort study.

Setting.

Outpatient hemodialysis facility affiliated with a large academic medical center.

Participants.

Of the 170 facility patients, 103 (61%) participated in the study.

Methods.

Swab specimens of the nares, axillae, and vascular access site were collected from participants weekly for 3 weeks and then monthly for 5 months. Demographic and clinical data were collected monthly for 12 months. Molecular analysis of MRSA isolates was performed.

Results.

The baseline MRSA carriage prevalence was 12%. Factors associated with MRSA carriage included a history of MRSA; failed renal transplantation; hospital admission within 6 months; and receipt of a first-generation cephalosporin, cefepime, or vancomycin. Six subjects acquired MRSA after enrollment (incidence, 1.2 per 100 patient-months at-risk; overall prevalence, 18%). Molecular analysis suggested that transmission occurred within the facility. The incidence of MRSA infection among carriers was 1.76 per 100 patient-months. Community-associated strains (ie, USA300) were isolated from 28% of carriers and at least 25% of infections.

Conclusions.

The prevalence of MRSA carriage and the incidence of infection among carriers were high among ambulatory hemodialysis patients, and community-associated MRSA was responsible for a large portion of the MRSA burden. A relatively high rate of MRSA acquisition was observed, with indirect evidence of intrafacility transmission. Additional studies are needed to confirm these findings and to identify effective and feasible methods to prevent MRSA transmission and infection among hemodialysis patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 9 , September 2011 , pp. 881 - 888
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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