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Methicillin-resistant Staphylococcus aureus nasal carriage among patients on haemodialysis with newly inserted central venous catheters

  • Nephrology - Original Paper
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Abstract

Background

Although methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is common among end-stage kidney disease patients undergoing haemodialysis, few studies were focused on MRSA nasal carriers among haemodialysis patients with central venous catheters (CVCs). The aim of this study is to evaluate the risk factors, various clinical outcomes and effect of decolonization for MRSA nasal colonization among patients on haemodialysis via CVCs.

Methods

This was a single-centre non-concurrent cohort study of 676 patients who had new haemodialysis CVCs inserted. They were all screened for MRSA colonization via nasal swabs and were categorized into two groups: MRSA carriers and MRSA noncarriers. Potential risk factors and clinical outcomes were analysed in both groups. All MRSA carriers were given decolonization therapy and the effect of decolonization on subsequent MRSA infection was also performed.

Results

Eighty-two patients (12.1%) were MRSA carriers. Multivariate analysis showed that MRSA carrier (OR 5.44; 95% CI 3.02–9.79), long-term care facility resident (OR 4.08; 95% CI 2.07–8.05), history of Staphylococcus aureus infection (OR 3.20; 95% CI 1.42–7.20) and CVC in situ > 21 days (OR 2.12; 95% CI 1.15–3.93) were independent risk factors for MRSA infection. There was no significant difference in all-cause mortality between MRSA carriers and noncarriers. The MRSA infection rates were similar between MRSA carriers with successful decolonization and those who had failed/incomplete decolonization in our subgroup analysis.

Conclusion

MRSA nasal colonization is an important cause of MRSA infection among haemodialysis patients with CVCs. However, decolonization therapy may not be effective in reducing MRSA infection.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Renal Unit, Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong SAR

    Yuen Ting Wong, Ching Shan Yeung, Wai Leung Chak & Chi Yuen Cheung

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  1. Yuen Ting Wong
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Correspondence to Chi Yuen Cheung.

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The authors have declared that no conflict of interest exists.

Ethical approval

This study was conducted in accordance with the Declaration of Helsinki and was approved by the local Research Ethics Committee [REC (KC/KE)-20-0158/ER-3].

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The requirement to obtain informed consent was waived based on the observational design.

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Wong, Y.T., Yeung, C.S., Chak, W.L. et al. Methicillin-resistant Staphylococcus aureus nasal carriage among patients on haemodialysis with newly inserted central venous catheters. Int Urol Nephrol 55, 2059–2066 (2023). https://doi.org/10.1007/s11255-023-03521-4

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