Journal of Clinical & Experimental Nephrology

Staphylococcus aureus Carriage and Bacteremia in Patients Treated with Hemodialysis: A Prospective M ulticenter Study

Background

Staphylococcus aureus bacteremia is frequent in hemodialysis patients. S. aureus colonization increases risk of bacteremia. Knowledge about bacterial factors increasing the risk of S. aureus bacteremia is sparse. The aims of this study were to examine S. aureus colonization and risk of bacteremia and death, and to compare strains causing bacteremia in hemodialysis patients versus other patients in the same population.

Methods

Observational, prospective multicenter study with 5-year follow-up including patients receiving chronic in-center hemodialysis in five facilities in Denmark. Baseline S. aureus nasal carriage and SABs were evaluated during follow-up. Population structures of SAB isolates from hemodialysis patients were compared to SAB isolates from the general population by comparing spa types. Time-to-event data were analyzed using Cox regression models and spa type differences using Chi-squared and Fisher exact tests.

Results

In total 336 patients were followed for 911.6 years (median 2.5 years (IQR 1.0-4.9)). Fifty patients (14.9%) experienced 72 SAB episodes. In the cohort 43% were S. aureus carriers at baseline with an increased risk of SAB compared to noncarriers (hazard ratio 2.63) and also death from all causes (hazard ratio 1.65). Hemodialysis patients experienced bacteremias with spa type’s t630, t648, t189, t474, t121 and t530 more often than the general population, a finding probably caused by within facility transfers and recurrences.

Conclusion

Hemodialysis patients colonized with S. aureus were at higher risk of SAB and all-cause death compared to noncarriers. The latter finding is novel. We did not find spa types with predilection for hemodialysis patients.

Author(s): Rie Glerup

Abstract | Full-Text | PDF

Share this