Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Clin J Am Soc Nephrol. 2011 Jan;6(1):167-74. doi: 10.2215/CJN.06270710. Epub 2010 Oct 14.
Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage is a recognized risk factor for subsequent endogenous infections. However, the association between MRSA carriage and patient survival in hemodialysis patients has not been established.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In March 2007, this prospective cohort study enrolled 306 outpatients under maintenance hemodialysis from a hospital-based dialysis center in Taiwan. They received two consecutive weekly nasal swab cultures at the beginning of the study. Patients having at least one positive culture of MRSA were defined as MRSA carriers. Subjects were followed up until December 31, 2008. The primary outcome was all-cause mortality. Main secondary outcomes were infection-related mortality and morbidity.
We identified 29 MRSA carriers (9.48%) at study entry. After a median of 613 days of follow-up, Kaplan-Meier analysis showed significant survival differences between MRSA carriers and noncarriers (log-rank P = 0.02). Compared with noncarriers, MRSA carriers had a 2.46-fold increased risk of dying from any cause, after adjusting for covariates at the start of follow-up. The adjusted hazard ratios of infection-related mortality and occurrence of subsequent S. aureus infection in carriers were 4.99 and 4.31, respectively.
A major limitation is the relatively small sample size of MRSA carriers. Nevertheless, we demonstrated that there may be an association between MRSA nasal carriage and poor clinical outcomes in an outpatient hemodialysis population. This underscores the need for routine surveillance of MRSA nasal carriage and should alert the physicians of a group at high risk of morbidity and mortality.
耐甲氧西林金黄色葡萄球菌（MRSA）鼻腔携带被认为是随后发生内源性感染的一个危险因素。然而，MRSA 携带与血液透析患者生存之间的关系尚未确定。
设计、设置、参与者和测量：2007 年 3 月，这项前瞻性队列研究纳入了来自台湾一家医院透析中心的 306 名维持性血液透析门诊患者。他们在研究开始时接受了两次连续的每周鼻腔拭子培养。至少有一次 MRSA 阳性培养的患者被定义为 MRSA 携带者。患者随访至 2008 年 12 月 31 日。主要结局是全因死亡率。主要次要结局是感染相关死亡率和发病率。
我们在研究开始时发现了 29 名 MRSA 携带者（9.48%）。在中位随访 613 天后，Kaplan-Meier 分析显示 MRSA 携带者和非携带者之间的生存差异具有统计学意义（对数秩 P = 0.02）。与非携带者相比，MRSA 携带者在随访开始时调整了混杂因素后，因任何原因死亡的风险增加了 2.46 倍。携带者感染相关死亡率和随后发生金黄色葡萄球菌感染的调整后危害比分别为 4.99 和 4.31。
主要限制是 MRSA 携带者的样本量相对较小。尽管如此，我们证明了在门诊血液透析人群中，MRSA 鼻腔携带可能与不良临床结局有关。这突显了对 MRSA 鼻腔携带进行常规监测的必要性，并提醒医生注意一组发病率和死亡率较高的患者。
