title: Prevalence of colonization with community-associated methicillin-resistant Staphylococcus aureus among end-stage renal disease patients and healthcare workers.
abstract: OBJECTIVE
  To evaluate the prevalence, epidemiologic features, and molecular characteristics of colonization with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) among hospitalized dialysis patients and their healthcare workers (HCWs).
  
  
  METHODS
  Prospective observational clinical and laboratory study of nasal colonization.
  
  
  METHODS
  A 600-bed urban academic medical center.
  
  
  METHODS
  One hundred twenty hospitalized dialysis inpatients and 100 HCWs.
  
  
  RESULTS
  Of 120 patients, 40 (33%) were colonized with S. aureus; 26 (65%) of these 40 were colonized with MRSA. Among the 26 MRSA isolates, 10 (38.5%) carried staphylococcal cassette chromosome (SCC) mec type IV (ie, CA-MRSA), and 7 of these 10 carried the genes for the Panton-Valentine leukocidin (PVL) toxin. Patients colonized with healthcare-associated MRSA strains and those colonized with CA-MRSA strains were similar, except for a higher frequency of a history of congestive heart failure among those with healthcare-associated MRSA strains (P=.014). Among 10 patients who presented with or developed an S. aureus infection while hospitalized, 8 were colonized with S. aureus, 7 with MRSA, and 3 with SCCmec type IV strains. Among 100 HCWs, 31 were colonized with S. aureus, including 6 with MRSA; 2 of the MRSA isolates belonged to CA-MRSA strains, and soft-tissue infections were reported in one of the HCWs and in the family member of the other HCW colonized with these strains.
  
  
  CONCLUSIONS
  There is a high rate of colonization with MRSA and CA-MRSA among hospitalized dialysis patients and their HCWs. As other studies have found, it appears that individuals are being colonized with both CA-MRSA strains and healthcare-associated MRSA strains.
authors.affiliation: St. John Hospital and Medical Center, and Wayne State University, Detroit, Michigan, USA. leonard.johnson@stjohn.org
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Johnson
authors.forename: Jinson
authors.initials: J
authors.lastname: Jose
authors.forename: Farah
authors.initials: F
authors.lastname: Yousif
authors.forename: Joan
authors.initials: J
authors.lastname: Pawlak
authors.forename: Louis D
authors.initials: LD
authors.lastname: Saravolatz
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial / Q000235:genetics; D005260:Female; D005838:Genotype; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification / Q000502:physiology*; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000150:complications* / Q000453:epidemiology*