The Prevalence of Resistant Bacterial Colonization in Chronic Hemodialysis Patients

Abstract

Backgound: Hospitalized dialysis patients are at increased risk for colonization and infection with resistant bacterial strains. Methods: We performed a cross-sectional analysis of the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) colonization in 198 hemodialysis outpatients, 75 of whom had longitudinal screening data from prior hospitalization. Nasal specimens for MRSA, perirectal specimens for VRE, and permanent catheter exit site specimens were collected. Results: MRSA colonization was present in 5.6% and VRE colonization in 3.14%. Univariate analyses revealed that prior exposure (defined as infection/colonization) with MRSA, hospitalization, and low serum albumin were associated with MRSA colonization. VRE colonization was associated with hospitalization, prior VRE or MRSA exposure, low serum albumin, and low ferritin. Multivariate analyses revealed MRSA colonization was predicted by prior MRSA exposure and VRE colonization was predicted by prior VRE exposure and number of hospitalizations. Among the 75 participants with longitudinal screening data, MRSA colonization was associated with prior MRSA history, and VRE colonization was associated with prior MRSA or VRE. Conclusions: Generally low rates of MRSA and VRE colonization were observed in hemodialysis outpatients. Prior hospital screening was predictive of future outpatient colonization and may be useful in risk assessment.

Multidrug-Resistant Gram-Negative Bacteria among Patients Who Require Chronic Hemodialysis

“…Clonal spread of VRE within the dialysis unit was not detected. Acquisition of VRE among these patients may have occurred during a previous hospitalization, a setting that has been frequently implicated in VRE spread between dialysis patients (2,16,25).…”

“…Vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) are among the antimicrobial-resistant bacteria that have been intensely investigated in this patient population (1)(2)(3). In the past few years, however, a concerning increase in the prevalence of infections caused by multidrug-resistant gram-negative bacteria (MDRGN) has been documented in other patient populations (4 -6).…”

“…The goals of this study were (1) to determine the percentage of chronic hemodialysis patients who are colonized with MDRGN and compare these rates with VRE and MRSA colonization, (2) to identify the risk factors that are associated with MDRGN colonization, and (3) to determine the mechanism of MDRGN acquisition. For achieving these goals, cultures were obtained at three intervals from patients who were receiving chronic hemodialysis at an outpatient unit to determine whether they were colonized with MDRGN, VRE, or MRSA at enrollment and whether they acquired these antimicrobial-resistant bacteria over time.…”

INFECTIOUS COMPLICATIONS OF ARTERIOVENOUS ePTFE GRAFTS FOR HEMODIALYSIS

“…Vancomycin resistant enterococci infections are also more often diagnosed in hemodialysis patients. In the USA the incidence of such infection has at least doubled 62,63 . The possible cause is excessive use of antibiotics, especially vancomycin and the third generation of cephalosporins 62,64 .…”

Infected Prosthetic Dialysis Arteriovenous Grafts: A Single Dialysis Center Study

“…One risk factor for MRSA infection is previous use of antibiotics. There also has been an increase in the prevalence of vancomycin-resistant enterococci (VRE) in dialysis patients [18,19]. A likely cause is the increased use of antibiotics, especially vancomycin and third-generation cephalosporins [18,20].…”