Nasal carriage of methicillin-resistant Staphylococcus aureus is associated with higher all-cause mortality in hemodialysis patients.
OBJECTIVE
Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage is a recognized risk factor for subsequent endogenous infections. However, the association between MRSA carriage and patient survival in hemodialysis patients has not been established.


METHODS
In March 2007, this prospective cohort study enrolled 306 outpatients under maintenance hemodialysis from a hospital-based dialysis center in Taiwan. They received two consecutive weekly nasal swab cultures at the beginning of the study. Patients having at least one positive culture of MRSA were defined as MRSA carriers. Subjects were followed up until December 31, 2008. The primary outcome was all-cause mortality. Main secondary outcomes were infection-related mortality and morbidity.


RESULTS
We identified 29 MRSA carriers (9.48%) at study entry. After a median of 613 days of follow-up, Kaplan-Meier analysis showed significant survival differences between MRSA carriers and noncarriers (log-rank P = 0.02). Compared with noncarriers, MRSA carriers had a 2.46-fold increased risk of dying from any cause, after adjusting for covariates at the start of follow-up. The adjusted hazard ratios of infection-related mortality and occurrence of subsequent S. aureus infection in carriers were 4.99 and 4.31, respectively.


CONCLUSIONS
A major limitation is the relatively small sample size of MRSA carriers. Nevertheless, we demonstrated that there may be an association between MRSA nasal carriage and poor clinical outcomes in an outpatient hemodialysis population. This underscores the need for routine surveillance of MRSA nasal carriage and should alert the physicians of a group at high risk of morbidity and mortality.
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Chun-Fu
CF
Lai
Chun-Hsing
CH
Liao
Mei-Fen
MF
Pai
Fang-Yeh
FY
Chu
Shih-Ping
SP
Hsu
Hung-Yuan
HY
Chen
Ju-Yeh
JY
Yang
Yen-Ling
YL
Chiu
Yu-Sen
YS
Peng
Shan-Chwen
SC
Chang
Kuan-Yu
KY
Hung
Tun-Jun
TJ
Tsai
Kwan-Dun
KD
Wu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D009666:Nose / Q000382:microbiology*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D013203:Staphylococcal Infections / Q000401:mortality*