The Prevalence of Nasal Carriage of Staphylococcus aureus and Associated Vascular Access-Related Septicemia Among Patients on Hemodialysis in Al-Hasa Region of Saudi Arabia.
A high Staphylococcus aureus nasal carriage rate is frequently seen among patients on hemodialysis (HD) and consequently, these patients appear to be at a higher risk for endogenous S. aureus associated vascular access-related septicemia (VARS). The prevalence of nasal carriage of S. aureus and it's impact on VARS with particular reference to age, sex and type of vascular access was studied in an HD cohort to recognize the most susceptible group(s) and plan prophylactic strategies accordingly. This study involved 208 end-stage renal disease (ESRD) patients on long-term HD from July 1997 to July 2000. Five standardized swabs from the anterior nares were taken. Persistent nasal carriage was defined by two or more positive cultures. Peripheral blood samples for culture and sensitivity were collected on clinical suspicion of septicemia. An overall prevalence of nasal carriage of 38.0% was observed. Nasal carriage rates were 85.7% among 75-84 year's and 50.0% in 65-74 year's age-groups. Central venous catheters (CVCs) recorded nine folds greater collective risk of developing S. aureus nasal carriage-related VARS than non-carrier group. No significant difference in S. aureus related incidence of VARS between non-carrier and nasal carrier groups was observed among those dialyzed through arteriovenous fistula (AVF). Elderly (>65 years) nasal carriers dialyzed through Central Venous Catheters, formed a high-risk group for S. aureus nasal carriage related VARS. The optimization of AVF placement might offer a safer, non-phamacological approach to reduce the S. aureus nasal carriage-related VARS besides possibly much desirable improvent in the quality of life of our senior citizens through decline in the frequency of hospitalizations.
Division of Nephrology, King Fahad Hospital, Hofuf, Al-Hasa, Saudi Arabia.
Anil K
AK
Saxena
B R
BR
Panhotra