title: An outbreak of methicillin-resistant Staphylococcus aureus infections related to central venous catheters for hemodialysis.
abstract: OBJECTIVE
  To determine risk factors for hemodialysis catheter-related bloodstream infections (HCRBSIs) and investigate whether use of maximal sterile barrier precautions would prevent HCRBSIs.
  
  
  METHODS
  Tertiary-care medical center hemodialysis unit.
  
  
  METHODS
  Open trial with historical comparison and case-control study of risk factors for HCRBSIs.
  
  
  METHODS
  Prospective surveillance was used to compare HCRBSI rates for 1 year before and after implementation of maximal sterile barrier precautions. A case-control study compared 50 case-patients with HCRBSI with 51 randomly selected control-patients.
  
  
  RESULTS
  The HCRBSI rate was 1.6% per 100 dialysis runs (CI95, 1.1%-2.3%) in the first year and 0.77% (CI95, 0.5%-1.1%) in the second year (P = .0106). The most frequent cause of HCRBSI was MRSA in the first year (15 of 32) and MSSA in the second year (13 of 18). Ten MRSA blood isolates in the first year were identical by PFGE. Diabetes mellitus was a risk factor for HCRBSI. Age, gender, site of hemodialysis central venous catheter (CVC), other underlying diseases, coma score, APACHE II score, serum albumin level, and cholesterol level were not associated with HCRBSI and did not change between the 2 years. Hospital stay was prolonged for case-patients (32.78 +/- 20.96 days) versus control-patients (22.75 +/- 17.33 days), but mortality did not differ.
  
  
  CONCLUSIONS
  Use of maximal sterile barrier precautions during the insertion of CVCs reduced HCRBSIs in dialysis patients and seemed cost-effective. Diabetes mellitus was associated with HCRBSI. An outbreak of MRSA in the first year was likely caused by cross-infection via medical personnel.
authors.affiliation: Division of Infectious Diseases, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taiwan, Republic of China.
authors.forename: Sai-Cheong
authors.initials: SC
authors.lastname: Lee
authors.forename: Kuo-Su
authors.initials: KS
authors.lastname: Chen
authors.forename: Chi-Jen
authors.initials: CJ
authors.lastname: Tsai
authors.forename: Ching-Chang
authors.initials: CC
authors.lastname: Lee
authors.forename: Hung Yu
authors.initials: HY
authors.lastname: Chang
authors.forename: Lai-Chu
authors.initials: LC
authors.lastname: See
authors.forename: Yu-Chin
authors.initials: YC
authors.lastname: Kao
authors.forename: Shu-Chu
authors.initials: SC
authors.lastname: Chen
authors.forename: Cheng-Hsu
authors.initials: CH
authors.lastname: Wang
mesh_terms: D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000191:economics / Q000706:statistics & numerical data*; D004196:Disease Outbreaks / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011159:Population Surveillance; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000191:economics / Q000453:epidemiology*; D013211:Staphylococcus aureus; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology