Saxena Anil K, Panhotra B R, Venkateshappa C K, Sundaram D S, Naguib Mohammed, Uzzaman Wahid, Al Mulhim Khalifa
Division of Nephrology, King Fahad Hospital and Tertiary Care Center, Hofuf, Al-Hasa, 31982, Saudi Arabia.
Ren Fail. 2002 Nov;24(6):763-77. doi: 10.1081/jdi-120015679.
Fairly higher nasal carriage rates among type-II diabetics place them at a greater risk of endogenous Staphylococcus aureus linked vascular access-related septicemia (VRS) that is also dependent on the type of vascular access used for hemodialysis (HD). The prevalence of nasal carriage of methicillin susceptible and methicillin-resistant S. aureus (MSSA and MRSA) and its impact on VRS was determined in order to identify most vulnerable group and plan potential prophylactic strategies, accordingly.
Five standardized nasal swab cultures were performed in 208 patients enrolled for long-term HD through July 1996 to July 1999. Persistent nasal carriage was defined by two or more positive cultures for MSSA or MRSA. Peripheral blood cultures were collected on clinical suspicion of septicemia.
The prevalence of type-II diabetes of 28.0% with 72.4% of nasal carriage rate and three folds higher S. aureus related VRS (RR-3.19, p<0.0001) than diabetic non-carriers on HD, was observed. Type-II diabetics also had higher MSSA and MRSA nasal carriage rates (53.4% and 19.0%) than non-diabetic nasal carriers (18.6 and 6.0%) yet, carried a comparable (RR-4.0 vs. 4.5) risk of VRS between MSSA and MRSA nasal carriers. Among diabetic type-II S. aureus nasal carriers, central venous catheters (CVCs) carried 35 and 38 times higher collective risk of developing MSSA and MRSA nasal carriage-related VRS respectively than Arterio-venous fistula (AVF). The AVF recorded the lowest risk of developing MSSA and MRSA nasal carriage-related VRS (0.013 and 0.010 episodes/patient-year) in both diabetic type-II MSSA and MRSA nasal carrier groups.
Diabetic type-II S. aureus nasal carriers on HD through CVCs make an extremely high-risk group for MSSA and MRSA nasal carriage-related VRS. The incidence of S. aureus nasal carriage-related VRS could reasonably be reduced through a challenging obligation of optimizing AVF prevalence in this high-risk group, while limiting the use of CVCs, at the same time.
II型糖尿病患者鼻腔携带率相对较高，这使他们面临更高的内源性金黄色葡萄球菌相关血管通路相关性败血症（VRS）风险，而这种风险也取决于用于血液透析（HD）的血管通路类型。为了确定最脆弱的群体并相应地制定潜在的预防策略，我们测定了甲氧西林敏感和耐甲氧西林金黄色葡萄球菌（MSSA和MRSA）的鼻腔携带率及其对VRS的影响。
对1996年7月至1999年7月期间登记接受长期血液透析的208例患者进行了五次标准化鼻腔拭子培养。持续性鼻腔携带定义为MSSA或MRSA两次或更多次培养阳性。在临床怀疑败血症时采集外周血培养。
观察到II型糖尿病患病率为28.0%，鼻腔携带率为72.4%，与HD上的糖尿病非携带者相比，金黄色葡萄球菌相关VRS高3倍（RR-3.19，p<0.0001）。II型糖尿病患者的MSSA和MRSA鼻腔携带率（分别为53.4%和19.0%）也高于非糖尿病鼻腔携带者（分别为18.6%和6.0%），然而，MSSA和MRSA鼻腔携带者的VRS风险相当（RR-4.0对4.5）。在II型糖尿病金黄色葡萄球菌鼻腔携带者中，中心静脉导管（CVC）发生MSSA和MRSA鼻腔携带相关VRS的总体风险分别比动静脉内瘘（AVF）高35倍和38倍。在II型糖尿病MSSA和MRSA鼻腔携带者组中，AVF发生MSSA和MRSA鼻腔携带相关VRS的风险最低（分别为0.013和0.010次/患者年）。
通过CVC进行HD的II型糖尿病金黄色葡萄球菌鼻腔携带者是MSSA和MRSA鼻腔携带相关VRS的极高风险群体。通过在这一高风险群体中优化AVF普及率的艰巨任务，同时限制CVC的使用，可以合理降低金黄色葡萄球菌鼻腔携带相关VRS的发生率。
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