THE IMPACT OF NASAL CARRIAGE OF METHICILLIN-RESISTANT AND METHICILLIN-SUSCEPTIBLE<i>STAPHYLOCOCCUS AUREUS</i>(MRSA &amp; MSSA) ON VASCULAR ACCESS-RELATED SEPTICEMIA AMONG PATIENTS WITH TYPE-II DIABETES ON DIALYSIS

Saxena, Anil Kumar; Panhotra, B. R.; Venkateshappa, C.; Sundaram, D.S.; Naguib, Mohammed; Uzzaman, Wahid; Mulhim, Khalifa Al

doi:10.1081/jdi-120015679

Cited by 41 publications

(33 citation statements)

References 28 publications

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“…Long-term hemodialysis patients, especially the elderly and diabetics, are more likely to be Staphylococcus aureus nasal carriers (up to 60%) (9)(10)(11) and are at a higher risk of infection due to dissemination of bacteria from nose to hands and beyond (10,11).…”

Section: Risk Factorsmentioning

confidence: 99%

Infective Endocarditis in Hemodialysis Patients

Pandey

Sam

2007

Int J Artif Organs

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Section: Risk Factorsmentioning

confidence: 99%

Infective Endocarditis in Hemodialysis Patients

Pandey

Sam

2007

Int J Artif Organs

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“…We used a Cox proportional hazard model to assess the effect of MRSA carriage on the study end points. Unadjusted hazard ratios were further adjusted in regression models by adding prespecified variables: age, gender, as well as the covariates (vascular access type, the presence of diabetes, recent hospitalization, recent use of antibiotics, and serum albumin level) that have been reported to have an association with MRSA carriage or infection in dialysis populations (4,13,14,22,23). All of the tests were two-tailed with significance defined by P values of less than 0.05.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Furthermore, the bulk of evidence concerning the risk of MRSA nasal carriage was limited to hospitalized patients. There were very few studies addressing the clinical effect of MRSA nasal carriage on hemodialysis (HD) patients, most of whom were freely ambulatory in the general community (4,13,14). For the establishment of public health intervention policy in this vulnerable population, we were interested in determining the effect of MRSA nasal carriage on all-cause mortality.…”

Section: Introductionmentioning

confidence: 99%

Nasal Carriage of Methicillin-resistant Staphylococcus aureus Is Associated with Higher All-Cause Mortality in Hemodialysis Patients

Lai¹,

Liao²,

Pai³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage is a recognized risk factor for subsequent endogenous infections. However, the association between MRSA carriage and patient survival in hemodialysis patients has not been established. Design, setting, participants, & measurementsIn March 2007, this prospective cohort study enrolled 306 outpatients under maintenance hemodialysis from a hospital-based dialysis center in Taiwan. They received two consecutive weekly nasal swab cultures at the beginning of the study. Patients having at least one positive culture of MRSA were defined as MRSA carriers. Subjects were followed up until December 31, 2008. The primary outcome was all-cause mortality. Main secondary outcomes were infection-related mortality and morbidity.Results We identified 29 MRSA carriers (9.48%) at study entry. After a median of 613 days of follow-up, Kaplan-Meier analysis showed significant survival differences between MRSA carriers and noncarriers (logrank P ϭ 0.02). Compared with noncarriers, MRSA carriers had a 2.46-fold increased risk of dying from any cause, after adjusting for covariates at the start of follow-up. The adjusted hazard ratios of infectionrelated mortality and occurrence of subsequent S. aureus infection in carriers were 4.99 and 4.31, respectively.Conclusions A major limitation is the relatively small sample size of MRSA carriers. Nevertheless, we demonstrated that there may be an association between MRSA nasal carriage and poor clinical outcomes in an outpatient hemodialysis population. This underscores the need for routine surveillance of MRSA nasal carriage and should alert the physicians of a group at high risk of morbidity and mortality.

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Section: N a Previous Issue Of The Canadian Journal Of Infectiousmentioning

confidence: 99%

“…Studies generally also point to colonization with S aureus as a risk for HD-related BSI (6,11). The relative roles of other factors such as poor hygiene (8), iron storage levels (12), immunosuppression (6), diabetes mellitus (11,12) and low albumin remain to be defined (13). Two studies (7,10) found that BSI rates varied substantially among dialysis centres, suggesting that being dialyzed at a particular centre may increase the risk for an HD-related BSI and that surveillance results may be used for quality improvement.…”

Section: N a Previous Issue Of The Canadian Journal Of Infectiousmentioning

confidence: 99%

Central Venous Catheter‐Associated Bloodstream Infections in Hemodialysis Patients: Another Patient Safety Bundle?

Johnston

Conly

2006

Canadian Journal of Infectious Diseases and Medical Microbiolog

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In a previous issue ofThe Canadian Journal of Infectious Diseases & Medical Microbiology, we reviewed the 'Safer Healthcare Now!' campaign's focus on reducing central venous catheter (CVC)-associated bloodstream infections (BSIs) as a way of improving patient safety (1). This initiative is focused on preventing CVC-associated BSIs in intensive care units. However, other patient groups are also at risk for CVC-related BSIs, suggesting that there are other individuals who would benefit from preventive efforts. A 1996 hospital-wide survey of nosocomial bacteremia in an Israeli university hospital (2) found that 9% of infected patients were on chronic hemodialysis. Surveillance in 73 hospitals in England between 1997 and 2001 found a CVC BSI rate of 21/1000 nephrology patients at risk who were hospitalized in teaching hospitals (3). This rate was similar to that found in special care neonatal units, although not quite one-half that of patients in a general intensive care unit. In a population-based survey performed in the Calgary Health Region from 2000 to 2002 (4), hemodialysis (HD) posed the greatest risk (RR 208.7; 95% CI 142.9 to 296.3) for acquiring severe BSI.

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THE IMPACT OF NASAL CARRIAGE OF METHICILLIN-RESISTANT AND METHICILLIN-SUSCEPTIBLESTAPHYLOCOCCUS AUREUS(MRSA & MSSA) ON VASCULAR ACCESS-RELATED SEPTICEMIA AMONG PATIENTS WITH TYPE-II DIABETES ON DIALYSIS

Cited by 41 publications

References 28 publications

Infective Endocarditis in Hemodialysis Patients

Infective Endocarditis in Hemodialysis Patients

Nasal Carriage of Methicillin-resistant Staphylococcus aureus Is Associated with Higher All-Cause Mortality in Hemodialysis Patients

Central Venous Catheter‐Associated Bloodstream Infections in Hemodialysis Patients: Another Patient Safety Bundle?

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