title: Methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia in haemodialysis patients.
abstract: BACKGROUND
  The aim of the study was to determine clinical and microbiological differences between patients with methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia (CRB) undergoing or not undergoing haemodialysis, and to compare outcomes.
  
  
  METHODS
  Prospective multicentre study conducted at 21 Spanish hospitals of patients with MRSA bacteraemia diagnosed between June 2008 and December 2009. Patients with MRSA-CRB were selected. Data of patients on haemodialysis (HD-CRB) and those not on haemodialysis (non-HD-CRB) were compared.
  
  
  RESULTS
  Among 579 episodes of MRSA bacteraemia, 218 (37.7%) were CRB. Thirty-four (15.6%) were HD-CRB and 184 (84.4%) non-HD-CRB. All HD-CRB patients acquired the infection at dialysis centres, while in 85.3% of the non-HD-CRB group the infection was nosocomial (p < .001). There were no differences in age, gender or severity of bacteraemia (Pitt score); comorbidities (Charlson score ≥ 4) were higher in the HD-CRB group than in the non-HD-CRB group (73.5% vs. 46.2%, p = .003). Although there were no differences in VAN-MIC ≥ 1.5 mg/L according to microdilution, using the E-test a higher rate of VAN-MIC ≥ 1.5 mg/L was observed in HD-CRB than in non-HD-CRB patients (63.3% vs. 44.1%, p = .051). Vancomycin was more frequently administered in the HD-CRB group than in the non-HD-CRB group (82.3% vs. 42.4%, p = <.001) and therefore the appropriate empirical therapy was significantly higher in HD-CRB group (91.2% vs. 73.9%, p = .029). There were no differences with regard to catheter removal (79.4% vs. 84.2%, p = .555, respectively). No significant differences in mortality rate were observed between both groups (Overall mortality: 11.8% vs. 27.2%, p = .081, respectively), but there was a trend towards a higher recurrence rate in HD-CRB group (8.8% vs. 2.2%, p = .076).
  
  
  CONCLUSIONS
  In our multicentre study, ambulatory patients in chronic haemodialysis represented a significant proportion of cases of MRSA catheter-related bacteraemia. Although haemodialysis patients with MRSA catheter-related bacteraemia had significantly more comorbidities and higher proportion of strains with reduced vancomycin susceptibility than non-haemodialysis patients, overall mortality between both groups was similar.
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de Bellvitge; Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. guillermocuervo@hotmail.com.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Cuervo
authors.affiliation: Department of Microbiology, H. Bellvitge, Barcelona, Spain. mcamoez@bellvitgehospital.cat.
authors.forename: Mariana
authors.initials: M
authors.lastname: Camoez
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de Bellvitge; Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. evelyn.shaw@bellvitgehospital.cat.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Shaw
authors.affiliation: Department of Microbiology, H. Bellvitge, Barcelona, Spain. adominguez@bellvitgehospital.cat.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Dominguez
authors.affiliation: Department of Infectious Diseases, H. Parc Taulí, Sabadell, Spain. oriol.gasch@gmail.com.
authors.forename: Oriol
authors.initials: O
authors.lastname: Gasch
authors.affiliation: Department of Infectious Diseases, H. Gregorio Marañón, Madrid, Spain. belenpadilla@telefonica.net.
authors.forename: Belén
authors.initials: B
authors.lastname: Padilla
authors.affiliation: Department of Infectious Diseases, H. Ramón y Cajal, Madrid, Spain. vicente.pintado@salud.madrid.org.
authors.forename: Vicente
authors.initials: V
authors.lastname: Pintado
authors.affiliation: Department of Infectious Diseases, H. Vall d'Hebrón, Barcelona, Spain. balmirante@vhebron.net.
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
authors.affiliation: Department of Infectious Diseases, H. Virgen del Rocío, Sevilla, Spain. josemolinagb@gmail.com.
authors.forename: José
authors.initials: J
authors.lastname: Molina
authors.affiliation: Department of Infectious Diseases, H. 12 de Octubre, Madrid, Spain. flmedrano@yahoo.es.
authors.forename: Francisco
authors.initials: F
authors.lastname: López-Medrano
authors.affiliation: Department of Microbiology, H. Son Espases, Palma de Mallorca, Spain. enrique.ruiz@ssib.es.
authors.forename: Enrique
authors.initials: E
authors.lastname: Ruiz de Gopegui
authors.affiliation: Department of Infectious Diseases, H. Clìnic, Barcelona, Spain. jamarti@clinic.ub.es.
authors.forename: José A
authors.initials: JA
authors.lastname: Martinez
authors.affiliation: Department of Infectious Diseases, H. Cruces, Bilbao, Spain. elena.bereciartuabastarrica@osakidetza.net.
authors.forename: Elena
authors.initials: E
authors.lastname: Bereciartua
authors.affiliation: Department of Infectious Diseases, H. Reina Sofía, Córdoba, Spain. ernando.rodriguez.lopez.sspa@juntadeandalucia.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodriguez-Lopez
authors.affiliation: Department of Microbiology, H. Marqués de Valdecilla, Santander, Spain. u5596@humv.es.
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernandez-Mazarrasa
authors.affiliation: Department of Infectious Diseases, H. Donostia, Donostia, Spain. miguelangel.goenagasanchez@osakidetza.net.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Goenaga
authors.affiliation: Department of Infectious Diseases, H. de la Santa Creu i Sant Pau, Barcelona, Spain. nbenito@santpau.es.
authors.forename: Natividad
authors.initials: N
authors.lastname: Benito
authors.affiliation: Department of Infectious Diseases, H. Virgen de Macarena, Sevilla, Spain. jesusrb@us.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodriguez-Baño
authors.affiliation: Department of Infectious Diseases, H. Terrassa, Terrassa, Spain. eespejo@cst.cat.
authors.forename: Elena
authors.initials: E
authors.lastname: Espejo
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de Bellvitge; Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. mpujol@bellvitgehospital.cat.
authors.forename: Miquel
authors.initials: M
authors.lastname: Pujol
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000472:pathogenicity*; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D013030:Spain; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin