title: Identifying Hemodialysis Patients With the Highest Risk of Staphylococcus aureus Endogenous Infection Through a Simple Nasal Sampling Algorithm.
abstract: In contrast to Staphylococcus aureus intermittent nasal carriers, persistent ones have the highest risk of infection. This study reports the usefulness of a simple nasal sampling algorithm to identify the S. aureus nasal carriage state of hemodialysis patients (HPs) and their subsequent risk of infection.From a cohort of 85 HPs, 76 were screened for S. aureus nasal carriage once a week during a 10-week period. The S. aureus nasal load was quantified by using either culture on chromogenic medium or fully automated real-time polymerase chain reaction assay. Molecular typing was used to compare strains from carriage and infection.The algorithm based on quantitative cultures was able to determine the status of S. aureus nasal carriage with a sensitivity of 95.8%, a specificity of 94.2%, a positive predictive value of 88.5%, and a negative predictive value of 98.0%. Of note, the determination of the S. aureus carriage state was obtained on the first nasal sample for all the 76 HPs, but 1 (98.7%). The algorithm based on quantitative polymerase chain reaction assay directly from the specimen yielded similar performances. During the 1-year follow-up after the last sampling episode, HPs classified as persistent nasal carriers with the algorithm were found to have a higher risk of S. aureus infection than those classified as nonpersistent carriers (P < 0.05), especially for infections of endogenous origin (P < 0.001).This simple algorithm is reliable for determining the S. aureus nasal carriage status in clinical practice and could contribute to characterize at an early stage of take-up patients with the highest risk of S. aureus infection.
authors.affiliation: From the GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes) (POV, JG, CHH, FG, AC, CM, EA, FL, OG, BP, EB-N, PB), University of Lyon, 42023 Saint-Etienne; Laboratory of Infectious Agents and Hygiene (POV, CHH, FG, AC, BP, PB); Infectious Diseases Department (JG, CC, FL, EB-N, PB); Nephrology-Dialysis-Transplantation Department (DT, CM, EA), University Hospital of Saint-Etienne, 42055 Saint-Etienne Cedex 02; and ARTIC42 Center (AA), 42270, Saint-Priest en Jarez, France.
authors.forename: Paul O
authors.initials: PO
authors.lastname: Verhoeven
authors.forename: Julie
authors.initials: J
authors.lastname: Gagnaire
authors.forename: Cyrille H
authors.initials: CH
authors.lastname: Haddar
authors.forename: Florence
authors.initials: F
authors.lastname: Grattard
authors.forename: Damien
authors.initials: D
authors.lastname: Thibaudin
authors.forename: Aida
authors.initials: A
authors.lastname: Afiani
authors.forename: Céline
authors.initials: C
authors.lastname: Cazorla
authors.forename: Anne
authors.initials: A
authors.lastname: Carricajo
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariat
authors.forename: Eric
authors.initials: E
authors.lastname: Alamartine
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lucht
authors.forename: Olivier
authors.initials: O
authors.lastname: Garraud
authors.forename: Bruno
authors.initials: B
authors.lastname: Pozzetto
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Botelho-Nevers
authors.forename: Philippe
authors.initials: P
authors.lastname: Berthelot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002353:Carrier State / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000382:microbiology*; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*