Staphylococcus aureus colonization in hemodialysis patients: a prospective 25 months observational study.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100967793 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2369 (Electronic) Linking ISSN: 14712369 NLM ISO Abbreviation: BMC Nephrol Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2000-
    • Subject Terms:
      Carrier State/*diagnosis ; Catheter-Related Infections/*diagnosis ; Methicillin-Resistant Staphylococcus aureus/*isolation & purification ; Renal Dialysis/*adverse effects ; Staphylococcal Infections/*diagnosis; Adult ; Aged ; Aged, 80 and over ; Arteriovenous Shunt, Surgical ; Bacteremia/diagnosis ; Bacteremia/microbiology ; Carrier State/microbiology ; Catheter-Related Infections/microbiology ; Catheter-Related Infections/mortality ; Cause of Death ; Central Venous Catheters/microbiology ; Cross Infection/microbiology ; Cross-Sectional Studies ; Female ; Follow-Up Studies ; Germany ; Humans ; Male ; Methicillin-Resistant Staphylococcus aureus/genetics ; Middle Aged ; Nose/microbiology ; Prospective Studies ; Renal Dialysis/mortality ; Staphylococcal Infections/microbiology ; Staphylococcal Infections/mortality ; Time Factors ; Young Adult
    • Abstract:
      Background: Dialysis patients are frequently exposed to Staphylococcus aureus due to stays in dialysis centers, hospitals or rest homes. The hemodialysis vascular access is a potential entry site for S. aureus, in particular when using a central venous catheter (CVC) which increases the risk of sepsis compared to arteriovenous (AV) fistula. We prospectively followed a cohort of 86 hemodialysis patients from an outpatient dialysis center over 25 months analyzing S. aureus carrier status, S. aureus infection rates and mortality.
      Methods: Demographic data and patients´ medical histories were collected and followed from all hemodialysis patients. Blood samples, nasal swabs and swabs from the hemodialysis vascular access site were taken every six months for a period of 25 months and tested for S. aureus. Strains were cultured and further characterized by spa PCR and microarray-based genotyping. Resulting data were compared with those from the general population.
      Results: In cross-sectional analyses, an average of 40% of hemodialysis patients were S. aureus carriers compared to 27% in the general population. Longitudinally, a total of 65% were S. aureus carriers: 16% were persistent carriers, 43% were intermittently colonized. The most common S. aureus lineage in the dialysis patient cohort was the clonal complex (CC) 8 and the spa type t008, while in the general population, the clonal complex CC30 dominates. During the study period, we observed six S. aureus-associated blood stream infections with one S. aureus attributable death. S. aureus carriers with an AV fistula were more densely colonized in the nasal mucosa compared to patients with a CVC. Overall mortality was lower for hemodialysis patients with a positive S. aureus carrier status compared to non-carriers (hazard ratio of 0.19).
      Conclusions: Compared to the general population, hemodialysis patients were more frequently colonized with S. aureus and displayed both different S. aureus colonization densities as well as lineages, possibly explained by more frequent exposure to health care environments. The lower overall mortality in carriers compared to non-carriers is intriguing and will be investigated in detail in the future.
      Trial Registration: ISRCTN 14385893 , 2. October 2018, retrospectively registered.
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    • Contributed Indexing:
      Keywords: AV fistula; CVC; Carrier; Clonal complex; Hemodialysis; MLST; Mortality; Renal; S. aureus; spa typing
    • Molecular Sequence:
      ISRCTN ISRCTN 14385893
    • Publication Date:
      Date Created: 20190508 Date Completed: 20200605 Latest Revision: 20200605
    • Publication Date:
      20231215
    • Accession Number:
      PMC6503363
    • Accession Number:
      10.1186/s12882-019-1332-z
    • Accession Number:
      31060511