A study of nasal carriage of methicillin-resistant staphylococcus aureus in patients undergoing hemodialysis in a tertiary care hospital of Punjab
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20213797Keywords:
Hemodialysis patients, Kirby-Bauer disc diffusion, MRSA, Nasal carriage, Staphylococcus aureusAbstract
Background: Infection is one of the major problems encountered in hemodialysis patients. The mortality rate among the patients undergoing hemodialysis remains unsatisfactorily high. Hemodialysis patients have higher nasal carriage rate of Staphylococcus aureus than the healthy population. In long-term hemodialysis patients, colonization is a significant problem and is associated with an increased risk of the bloodstream infections. The antimicrobial resistance to this pathogen is increasing rapidly, and the consequences of methicillin resistance for the outcomes of Staphylococcus aureus infections are drastic.
Methods: Two swabs were collected from anterior nares of patients undergoing hemodialysis, and then these swabs were transferred to microbiology laboratory for processing. Isolated strains were subjected to antimicrobial susceptibility testing using Kirby-Bauer disc diffusion. Methicillin resistance was detected by using cefoxitin disc. Inhibition zone diameters were measured as per CLSI criteria. Vancomycin screen agar test was done. Brain heart infusion agar plates containing 6 µg/ml of vancomycin were used. S. aureus ATCC 29213 was used as reference strain.
Results: It was observed that 38% (38/100) of the hemodialysis patients were carriers of S. aureus followed by CoNS, followed by aerobic spore bearers. All the S. aureus isolates (100%, 38/38) were methicillin-resistant (MRSA).
Conclusions: Staphylococcal nasal carrier status in hemodialysis patients along with antibiotic susceptibility testing should be done in routine and infection control practices should be followed to prevent the transmission of MRSA among chronic hemodialysis patients.
References
Churchill DN, Taylor DW, Cook RJ, LaPlante P, Barre P, Cartier P, et al. Canadian hemodialysis morbidity study. Am J Kidney Dis. 1992;19:214-34.
Luzar MA, Coles GA, Faller B, Slingeneyer A, Dah GD, Briat C, et al. Staphylococcus aureus nasal carriage and infection in patients on continuous ambulatory peritoneal dialysis. N Engl J Med. 1990;322:505-9.
Monsen T, Olofsson C, Ronnmark M, Wistrom J. Clonal spread of Staphylococci among patients with peritonitis associated with continuous ambulatory peritoneal dialysis. Kidney Int. 2000;57:613-8.
Nouwen JL, Fieren MW, Snijders S, Verbrugh HA, van Belkum A. Persistent (not intermittent) nasal carriage of Staphylococcus aureus is the determinant of CPD-related infections. Kidney Int. 2005;67:1084-92.
Bradley JR, Evans DB, Calne RY. Long-term survival in hemodialysis patients. Lancet. 1987;1:295-6.
Neff MS, Eiser AR, Slifkin RF, Baum M, Baez A, Gupta S, et al. Patients surviving 10 years of hemodialysis. Am J Med. 1983;74:996-1004.
Shinefield H, Black S, Fattom A, Horwith G, Rasgon S, Ordonez J, et al. Use of a Staphylococcus aureus conjugate vaccine in patients receiving hemodialysis. N Engl J Med. 2002;346:491-6.
Zimakoff J, Bangsgaard PF, Bergen L, Baago-Nielsen J, Daldorph B, Espersen F, et al. Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centers in Denmark. The Danish study group of peritonitis in dialysis (DASPID). J Hosp Infect. 1996;33:289-300.
Saxena AK, Panhotra BR, Venkateshappa CK, Sundaram DS, Naguib M, Uzzaman W, et al. The impact of nasal carriage of methicillin-resistant and methicillin-susceptible Staphylococcus aureus (MRSA and MSSA) on vascular access-related septicemia among patients with type-II diabetes on dialysis. Renal Failure. 2002;24:763-77.
Yu VL, Goetz A, Wagener M, Smith PB, Rihs JD, Hanchett J, et al. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis efficacy of antibiotic prophylaxis. N Engl J Med. 1986;315:91-6.
Vandecasteele SJ, Boelaert JR, de-Vriese AS. Staphylococcus aureus infections in hemodialysis: what a nephrologist should know. Clin J Am Soc Nephrol. 2009;4:1388-400.
Francioli P, Masur H. Complications of Staphylococcus aureus bacteremia: occurrence in patients undergoing long-term hemodialysis. Arch Intern Med. 1982;142(9):1655-8.
Johnson DW, MacGinley R, Kay TD, Hawley CM, Campbell SB, Isbel NM, et al. A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed hemodialysis catheters. Nephrol Dial Transplant. 2002;17(10):1802-7.
Lu PL, Tsai JC, Chiu YW, Chang FY, Chen YW, Hsiao CF, et al. Methicillin-resistant Staphylococcus aureus carriage, infection and transmission in dialysis patients, healthcare workers and their family members. Nephrol Dial Transplant. 2007;25(5):1659-65.
Koziol-Montewka M, Chudnicka A, Ksiazek A, Majdan M. Rate of Staphylococcus aureus nasal carriage in immunocompromised patients receiving haemodialysis treatment. Int J Antimicrob Agents. 2001;18:193-60
Sathish JV, Malleshappa P, Yashaswini MK, Shariff S. Influence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage on MRSA bloodstream infections among patients on chronic hemodialysis. Dial Traspl. 2014;35(4):143-7.
Kozioł-Montewka M, Szczepanik A, Baranowicz I, Jozwiak L, Ksiazek A, Kaczor D. The investigation of Staphylococcus aureus and coagulase-negative staphylococci nasal carriage among patients undergoing haemodialysis. Microbiol Res. 2006;161(4):281-7.
Ghasemian R, Najafi N, Makhlough A, Khademloo M. Frequency of nasal carriage of Staphylococcus aureus and its antimicrobial resistance pattern in patients on hemodialysis. Iranian J kidney Dis. 2010;4(3):218.
Saxena AK, Panhotra BR, Chopra R. Advancing age and the risk of nasal carriage of Staphylococcus aureus among patients on long- term hospital-based hemodialysis. Ann Saudi Med. 2004;24(5):337-42.
Celik G, Gulcan A, Dikici N, Gulcan E. Prevalence of nasal Staphylococcus aureus carriage in the patients undergoing hemodialysis and evaluation of risk factors and laboratory parameters. Renal failure. 201;33(5):494-8.
Deepika G, Anaparthy U, Krishna PB. Prevalence of nasal carriage of MRSA among patients undergoing haemodialysis and in healthcare workers working in haemodialysis units. JPSI. 2015;4(1):40-3.
Lai CF, Liao CH, Pai MF, Chu FY, Hsu SP, Chen HY, et al. Nasal carriage of methicillin-resistant Staphylococcus aureus is associated with higher all-cause mortality in hemodialysis patients. Clin Am Soc Nephrol. 2011;6(1):167-74.
Lederer SR, Riedelsdorf G, Schiffl H. Nasal carriage of methicillin resistant Staphylococcus aureus: the prevalence, patients at risk and the effect of elimination on outcomes among outclinic haemodialysis patients. Eur J Med Res. 2007;12(7):284.
David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev. 2010;23:616-87.
Nissenson AR, Dylan ML, Griffiths RI, Yu HT, Dean BB, Danese MD, et al. Clinical and economic outcomes of Staphylococcus aureus septicemia in ESRD patients receiving hemodialysis. Am J Kidney Dis. 2005;46(2):301-8.
Reed SD, Friedman JY, Engemann JJ, Griffiths RI, Anstrom KJ, Kaye KS, et al. Costs and outcomes among hemodialysis- dependent patients with methicillin-resistant or methicillin- susceptible Stapylococcus aureus bacteremia. Infect Control Hosp Epidemiol. 2005;26(2):175-83.
Centers for Disease Control: invasive Methicillin-Resistant Staphylococcus aureus infections among dialysis patients, United States, 2005. Morb Mortal Wkly Rep. 2007;56:197-9.
Fomda BA, Thokar MA, Khan A, Bhat JA, Zahoor D, Bashir G, et al. Nasal carriage of Methicillin-resistant Staphylococcus aureus among healthy population of Kashmir, India. Indian J Med Microbiol. 2014;32(1):39-43.
Tiwari HK, Sen MR. Emergence of vancomycin resistant Staphylococcus aureus (VRSA) from a tertiary care hospital from northern part of India. BMC Infect Dis. 2006;6:156.
Clinical and Laboratory standards institute (CLSI). Performance standards for antimicrobial susceptibility testing; 26th informational supplement. Wayne, PA: CLSI;2016.
Lu PL, Chin LC, Peng CF, Chiang YH, Chen TP, Ma L, et al. Risk factors and molecular analysis of community methicillin-resistant Staphylococcus aureus carriage. J Clin Microbiol. 2005;43:132-9.
