title: The prevalence of resistant bacterial colonization in chronic hemodialysis patients.
abstract: BACKGROUND
  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.
authors.affiliation: Section on Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1053, USA. ahadley@wfubmc.edu
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Hadley
authors.forename: Tobi B
authors.initials: TB
authors.lastname: Karchmer
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Russell
authors.forename: Debra G
authors.initials: DG
authors.lastname: McBride
authors.forename: Barry I
authors.initials: BI
authors.lastname: Freedman
mesh_terms: D003430:Cross-Sectional Studies; D016208:Databases, Factual; D016983:Enterococcus / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D017053:Infection Control; D007676:Kidney Failure, Chronic / Q000382:microbiology* / Q000628:therapy; D008297:Male; D016106:Methicillin Resistance; D015995:Prevalence; D006435:Renal Dialysis; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D014505:Urban Population; D020713:Vancomycin Resistance