Lederer S R, Riedelsdorf G, Schiffl H
KfH Nierenzentrum Muenchen-Laim, Elsenheimerstr. 63, 80336 Muich, Germany.
Eur J Med Res. 2007 Jul 26;12(7):284-8.
Haemodialysis (HD) patients with meticillin-resistant Staphylococcus aureus (MRSA) infections face high morbidity and mortality. Nasal carriage of Staphylococcus aureus is known to play an important role as an endogenous source for HD-access-related infections that contribute significantly to morbidity, mortality and cost of end-stage renal disease (ESRD) management. This prospective investigation in regular out-clinic haemodialysis patients was undertaken to estimate the prevalence of S.aureus nasal carriage, to define patient groups at risk and to evaluate the effect of elimination on outcomes among outclinic haemodialysis patients.
136 HD patients without signs of overt clinical infection (48 women, 88 men, age 22-88 years) were screened at least twice for the nasal carriage for meticillin-susceptible SA (MSSA) or meticillin-resistant SA (MRSA). Nasal carriage of S. aureus was related to demographic (age, gender, duration on HD), comorbidity (diabetes, malignancy) and exposure to health care (dialysis staff, hospitalisation). Nasal carriers for MRSA received standardized mupirocin therapy and were followed up for elimination and infections for 1 year.
The prevalence of nasal carriage for staphylococcus aureus was 53 % (41 % MSSA, 12 % MRSA). Compared with patients showing no colonization or with MSSA carriers, the 16 patients with nasal carriage for MRSA were older and more likely to have acquired the bacteria while hospitalised. Genotyping of MRSA isolates revealed different strains in patients and care-providers. Mupirocin eliminated MRSA in all patients, none of these patients experienced an infection caused by staphylococcus aureus, confirming the known value of MRSA elimination from other studies.
Elderly patients hospitalised for surgery constitute a high risk group for nasal carriage for MRSA. Early diagnosis may help prevent clinically relevant infection. Elimination of colonization by mupirocin appears to be an attractive preventive strategy.
耐甲氧西林金黄色葡萄球菌（MRSA）感染的血液透析（HD）患者面临着较高的发病率和死亡率。已知金黄色葡萄球菌的鼻腔定植作为HD通路相关感染的内源性来源发挥着重要作用，而HD通路相关感染对终末期肾病（ESRD）管理的发病率、死亡率和成本有显著影响。本前瞻性研究针对定期门诊血液透析患者进行，旨在估计金黄色葡萄球菌鼻腔定植的患病率，确定高危患者群体，并评估清除定植对门诊血液透析患者结局的影响。
对136例无明显临床感染迹象的HD患者（48例女性，88例男性，年龄22 - 88岁）至少进行两次鼻腔筛查，以检测对甲氧西林敏感的金黄色葡萄球菌（MSSA）或耐甲氧西林金黄色葡萄球菌（MRSA）的定植情况。金黄色葡萄球菌的鼻腔定植与人口统计学因素（年龄、性别、HD持续时间）、合并症（糖尿病、恶性肿瘤）以及医疗接触（透析工作人员、住院治疗）有关。MRSA鼻腔携带者接受标准化莫匹罗星治疗，并随访1年以观察定植清除情况和感染情况。
金黄色葡萄球菌鼻腔定植的患病率为53%（41%为MSSA，12%为MRSA）。与未定植或MSSA携带者相比，16例MRSA鼻腔携带者年龄更大，且更有可能在住院期间获得该细菌。对MRSA分离株进行基因分型显示，患者和医护人员中的菌株不同。莫匹罗星清除了所有患者的MRSA，这些患者均未发生由金黄色葡萄球菌引起的感染，证实了其他研究中已知的MRSA清除的价值。
因手术住院的老年患者是MRSA鼻腔定植的高危人群。早期诊断有助于预防临床相关感染。用莫匹罗星清除定植似乎是一种有吸引力的预防策略。
