Lu Po-Liang, Tsai Jer-Chia, Chiu Yi-Wen, Chang Feng-Yee, Chen Ya-Wei, Hsiao Chin-Fu, Siu L K
Division of Clinical Research, National Health Research Institutes, Rm. 7118, 7/F, No.161, Sec. 6, Min-Chuan East Rd, Taipei, 114, Taiwan.
Nephrol Dial Transplant. 2008 May;23(5):1659-65. doi: 10.1093/ndt/gfm806. Epub 2007 Nov 19.
Carriage and subsequent infection with methicillin resistant S. aureus (MRSA) and its transmission between hospital and community settings have not been studied in dialysis patients and their contacts.
Surveillance for nasal MRSA carriage and infection among dialysis patients, healthcare workers (HCWs) and their family members in a dialysis centre was prospectively undertaken during three time periods within 1 year. Molecular typing was used to determine epidemiological relationship.
Among 1687 samples collected, MRSA colonization rates were 2.41% (2/83) for peritoneal dialysis patients and 2.36% (12/509) for haemodialysis patients. Five (5/14) subjects subsequently had MRSA infection. The clinical MRSA isolates had the same molecular type as the colonized strains of the same person, indicating MRSA colonization preceded clinical infection. Significantly higher MRSA nasal carriage rates were observed among family members of HCWs than family members of dialysis patients (P = 0.0024). Only three major clones were observed. Pulmonary diseases (OR: 4.873, 95% CI: 1.668-14.235), recent admission to a hospital (OR: 2.797, 95% CI: 1.291-6.059) and recent antibiotics usage (OR: 2.319, 95% CI: 1.053-5.104) were also significantly associated with MRSA carriage.
Transmission of MRSA among dialysis patients, HCWs and their family members in a dialysis unit could be inferred. Monitoring and eradication of MRSA from patients, HCWs and their family members should be considered to prevent continuous spread between healthcare facilities and the community.
耐甲氧西林金黄色葡萄球菌（MRSA）的携带情况以及随后的感染情况，及其在透析患者及其接触者之间在医院和社区环境中的传播尚未得到研究。
在1年内的三个时间段前瞻性地对一家透析中心的透析患者、医护人员（HCWs）及其家庭成员进行鼻腔MRSA携带和感染监测。采用分子分型来确定流行病学关系。
在收集的1687份样本中，腹膜透析患者的MRSA定植率为2.41%（2/83），血液透析患者为2.36%（12/509）。随后有5名（5/14）受试者发生了MRSA感染。临床MRSA分离株与同一人的定植菌株具有相同的分子类型，表明MRSA定植先于临床感染。医护人员家庭成员的MRSA鼻腔携带率显著高于透析患者家庭成员（P = 0.0024）。仅观察到三个主要克隆。肺部疾病（比值比：4.873，95%置信区间：1.668 - 14.235）、近期住院（比值比：2.797，95%置信区间：1.291 - 6.059）和近期使用抗生素（比值比：2.319，95%置信区间：1.053 - 5.104）也与MRSA携带显著相关。
可以推断出MRSA在透析单元的透析患者、医护人员及其家庭成员之间的传播情况。应考虑对患者、医护人员及其家庭成员进行MRSA监测和清除，以防止在医疗机构和社区之间的持续传播。
