title: Prevalence, persistence, and microbiology of Staphylococcus aureus nasal carriage among hemodialysis outpatients at a major New York Hospital.
abstract: The study aimed to determine the natural history of Staphylococcus aureus nasal colonization in hemodialysis outpatients. Surveillance cultures were taken from patients presenting for hemodialysis or routine care to identify S. aureus nasal carriers. A prospective cohort study was performed to identify risks for persistent colonization. Detailed microbiologic and molecular studies of colonizing isolates were performed. Only 23/145 (15.9%) dialysis patients were persistently colonized, and only HIV-positive status was associated with persistence (P = 0.05). Prior hospitalization was the only risk factor for methicillin-resistant S. aureus carriage (OR 2.5, P = 0.03). In isolates from patients with ≤ 42 days of vancomycin exposure, vancomycin minimum bactericidal concentrations (MBCs) increased with duration of exposure. Among dialysis patients, S. aureus colonization was limited and transient; only HIV status was associated with persistence. Nevertheless, duration of vancomycin exposure was associated with increasing vancomycin MBCs. Vancomycin exposure in S. aureus carriers may be involved in increasing resistance.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Alexander
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Morgan
authors.forename: Sandra
authors.initials: S
authors.lastname: Kesh
authors.forename: Scott A
authors.initials: SA
authors.lastname: Weisenberg
authors.forename: Janice M
authors.initials: JM
authors.lastname: Zaleskas
authors.forename: Anna
authors.initials: A
authors.lastname: Kaltsas
authors.forename: James M
authors.initials: JM
authors.lastname: Chevalier
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Silberzweig
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Barrón
authors.forename: Jose R
authors.initials: JR
authors.lastname: Mediavilla
authors.forename: Barry N
authors.initials: BN
authors.lastname: Kreiswirth
authors.forename: Kyu Y
authors.initials: KY
authors.lastname: Rhee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications; D006436:Hemodialysis Units, Hospital; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000382:microbiology*; D009518:New York / Q000453:epidemiology; D010045:Outpatients; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin