Original Report: Patient-Oriented, Translational Research

The Prevalence of Resistant Bacterial Colonization in Chronic Hemodialysis Patients
Alexander C. Hadley^a, Tobi B. Karchmer^b, Gregory B. Russell^c, Debra G. McBride^a, Barry I. Freedman^a

Sections on
^aNephrology and
^bInfectious Diseases, Department of Internal Medicine, and
^cDepartment of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, N.C., USA

Address of Corresponding Author

Am J Nephrol 2007;27:352-359 (DOI: 10.1159/000103383)

  Key Words

• Bacterial colonization
• Chronic kidney disease
• Dialysis
• Methicillin-resistant Staphylococcus aureus
• Bacteria, resistant
• Vancomycin-resistant Enterococcus

  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.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

Alexander C. Hadley, MD
Department of Internal Medicine/Nephrology
Wake Forest University School of Medicine, Medical Center Boulevard
Winston-Salem, NC 27157-1053 (USA)
Tel. +1 336 716 4650, Fax +1 336 716 4318, E Mail ahadley@wfubmc.edu

  Article Information

Received: January 31, 2007
Accepted: April 26, 2007
Published online: May 31, 2007
Number of Print Pages : 8
Number of Figures : 0, Number of Tables : 5, Number of References : 19