title: Methicillin-resistant Staphylococcus aureus carriage, infection and transmission in dialysis patients, healthcare workers and their family members.
abstract: BACKGROUND
  Carriage and subsequent infection with methicillin resistant S. aureus (MRSA) and its transmission between hospital and community settings have not been studied in dialysis patients and their contacts.
  
  
  METHODS
  Surveillance for nasal MRSA carriage and infection among dialysis patients, healthcare workers (HCWs) and their family members in a dialysis centre was prospectively undertaken during three time periods within 1 year. Molecular typing was used to determine epidemiological relationship.
  
  
  RESULTS
  Among 1687 samples collected, MRSA colonization rates were 2.41% (2/83) for peritoneal dialysis patients and 2.36% (12/509) for haemodialysis patients. Five (5/14) subjects subsequently had MRSA infection. The clinical MRSA isolates had the same molecular type as the colonized strains of the same person, indicating MRSA colonization preceded clinical infection. Significantly higher MRSA nasal carriage rates were observed among family members of HCWs than family members of dialysis patients (P = 0.0024). Only three major clones were observed. Pulmonary diseases (OR: 4.873, 95% CI: 1.668-14.235), recent admission to a hospital (OR: 2.797, 95% CI: 1.291-6.059) and recent antibiotics usage (OR: 2.319, 95% CI: 1.053-5.104) were also significantly associated with MRSA carriage.
  
  
  CONCLUSIONS
  Transmission of MRSA among dialysis patients, HCWs and their family members in a dialysis unit could be inferred. Monitoring and eradication of MRSA from patients, HCWs and their family members should be considered to prevent continuous spread between healthcare facilities and the community.
authors.affiliation: Division of Clinical Research, National Health Research Institutes, Rm. 7118, 7/F, No.161, Sec. 6, Min-Chuan East Rd, Taipei, 114, Taiwan.
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lu
authors.forename: Jer-Chia
authors.initials: JC
authors.lastname: Tsai
authors.forename: Yi-Wen
authors.initials: YW
authors.lastname: Chiu
authors.forename: Feng-Yee
authors.initials: FY
authors.lastname: Chang
authors.forename: Ya-Wei
authors.initials: YW
authors.lastname: Chen
authors.forename: Chin-Fu
authors.initials: CF
authors.lastname: Hsiao
authors.forename: L K
authors.initials: LK
authors.lastname: Siu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000382:microbiology / Q000635:transmission; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000382:microbiology / Q000635:transmission; D005190:Family; D005260:Female; D006282:Health Personnel; D006801:Humans; D007223:Infant; D017758:Infectious Disease Transmission, Patient-to-Professional; D017757:Infectious Disease Transmission, Professional-to-Patient; D008297:Male; D016106:Methicillin Resistance / Q000235:genetics; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000635:transmission*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*