Köseoğlu Ozlem, Sayın Kutlu Selda, Cevahir Nural
Denizli State Hospital, Clinic of Infectious Diseases, Denizli, Turkey.
Mikrobiyol Bul. 2012 Jan;46(1):106-12.
Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) is frequent among hemodialysis patients and lead to increased morbidity and mortality rates. It is known that nasal colonization plays an important role for the development of MRSA infections. The aim of this study was to determine the prevalence and risk factors for MRSA colonization among outpatients undergoing hemodialysis. A total of 466 adult patients (199 female, 267 male; age range: 18-89 years, mean age: 55.8 ± 15.1 years) who were under hemodialysis between September-December 2008 in different health centers at Pamukkale/ Denizli region, Turkey, were included in the study. Swab samples obtained from anterior nares of patients were cultivated on sheep-blood agar and mannitol-salt agar media. The isolates were identified by conventional bacteriological methods. S.aureus strains were isolated from 204 (43.8%) patients and 34 (16.7%) were found methicillin-resistant. Thus the rate of MRSA colonization in hemodialysis patients was detected as 7.3% (34/466). All of the MRSA strains were found susceptible to vancomycin, linezolid and tigecycline, while the resistance rates for the other antimicrobial agents were as follows: 70.6% to azithromycin and claritromycin; 64.7% to erythromycin; %58.8 to clindamycin, gentamicin and trimethoprim-sulfamethoxazole; 55.9% to ciprofloxacin; 44.1% to tetracycline and rifampin; 5.9% to chloramphenicol. Inducible clindamycin resistance in MRSA isolates was %23.5 (8/34), and multidrug resistance rate was 76.5% (26/34). Multivariate analysis revealed that the history of previous hospitalization within a year [odds ratio (OR), 3.426; 95% confidence interval (CI), 1.595-7.361, p= 0.002] and the presence of chronic obstructive lung disease (OR, 5.181; 95% CI, 1.612-16.648, p= 0.006) were independent risk factors for MRSA colonization in this population. A better understanding of the prevalence and risk factors for nasal MRSA colonization among hemodialysis population may hold significant implications for both the treatment strategies and prevention of MRSA infections to establish appropriate infection control measures.
耐甲氧西林金黄色葡萄球菌（MRSA）引起的感染在血液透析患者中很常见，会导致发病率和死亡率上升。已知鼻腔定植在MRSA感染的发生中起重要作用。本研究的目的是确定接受血液透析的门诊患者中MRSA定植的患病率及危险因素。本研究纳入了2008年9月至12月期间在土耳其代尼兹利省棉花堡地区不同医疗中心接受血液透析的466例成年患者（199例女性，267例男性；年龄范围：18 - 89岁，平均年龄：55.8±15.1岁）。从患者前鼻孔采集的拭子样本接种在羊血琼脂和甘露醇盐琼脂培养基上。采用常规细菌学方法鉴定分离株。从204例（43.8%）患者中分离出金黄色葡萄球菌菌株，其中34例（16.7%）被发现对甲氧西林耐药。因此，血液透析患者中MRSA定植率为7.3%（34/466）。所有MRSA菌株对万古霉素、利奈唑胺和替加环素敏感，而对其他抗菌药物的耐药率如下：对阿奇霉素和克拉霉素为70.6%；对红霉素为64.7%；对克林霉素、庆大霉素和甲氧苄啶 - 磺胺甲恶唑为58.8%；对环丙沙星为55.9%；对四环素和利福平为44.1%；对氯霉素为5.9%。MRSA分离株中诱导型克林霉素耐药率为23.5%（8/34），多重耐药率为76.5%（26/34）。多因素分析显示，一年内既往住院史[比值比（OR），3.426；95%置信区间（CI），1.595 - 7.361，p = 0.002]和慢性阻塞性肺疾病的存在（OR，5.181；95%CI，1.612 - 16.648，p = 0.006）是该人群中MRSA定植的独立危险因素。更好地了解血液透析人群中鼻腔MRSA定植的患病率和危险因素，对于制定治疗策略和预防MRSA感染以建立适当的感染控制措施可能具有重要意义。
