Department of Renal Medicine, Royal Derby Hospital, UK.
Nephron Clin Pract. 2012;120 Suppl 1:c233-45. doi: 10.1159/000342856. Epub 2012 Sep 1.
Infection remains one of the leading causes of death in patients with end-stage renal failure (ESRF) receiving dialysis. Since April 2007, all centres providing renal replacement therapy in England have been required to provide additional data on patients with Methicillin Resistant Staphylococcus Aureus (MRSA) infection. From January 2011 this has also been required for patients with Methicillin Sensitive Staphylococcus Aureus (MSSA). MRSA data for 2009-2011 and the first 6 months of MSSA data are reported.
Potential bacteraemia were identified by the Health Protection Agency based on clinical details provided and the clinical setting. The records were 'shared' with the parent renal centre who then complete the additional data on the HCAI-DCS website. Centres were also contacted by phone and email as a further validation step.
From April 2009-2010 there were 77 confirmed episodes of MRSA bacteraemia at a median rate of 0.25 per 100 prevalent dialysis patients. This number decreased to 61 episodes between April 2010-2011 at a median rate of 0 per 100 prevalent dialysis patients. Overall there has been an 82% reduction in absolute episodes since the first year of mandatory reporting in 2007. The incidence of bacteraemia in patients with a central venous catheter was approximately six fold higher than in those with an AV fistula. From 1st January to 30th June 2011 there were 160 episodes of MSSA bacteraemia with a rate of 1.06 episodes per 100 dialysis patients, again the risk was six fold higher in patients with a CVC.
Overall rates of MRSA bacteraemia in dialysis patients continued to fall although there remained variation between renal centres. Initial data from the early days of MSSA reporting suggested high rates of infection and an even greater variation between renal centres. This requires confirmation from future data collection.
感染仍然是接受透析的终末期肾衰竭（ESRF）患者死亡的主要原因之一。自 2007 年 4 月以来，英国所有提供肾脏替代治疗的中心都被要求提供耐甲氧西林金黄色葡萄球菌（MRSA）感染患者的额外数据。自 2011 年 1 月起，对耐甲氧西林金黄色葡萄球菌（MSSA）患者也有此要求。报告了 2009-2011 年的 MRSA 数据和 MSSA 数据的前 6 个月。
根据提供的临床详细信息和临床环境，由英国卫生保护局确定潜在的菌血症。记录被“共享”给母肾中心，然后该中心在 HCAI-DCS 网站上完成额外的数据。还通过电话和电子邮件与中心联系，作为进一步的验证步骤。
从 2009 年 4 月至 2010 年，有 77 例确诊的 MRSA 菌血症，中位数为每 100 例流行透析患者 0.25 例。这个数字在 2010 年 4 月至 2011 年期间减少到 61 例，中位数为每 100 例流行透析患者 0 例。自 2007 年强制性报告的第一年以来，绝对病例数减少了 82%。有中央静脉导管的患者发生菌血症的风险约为动静脉瘘患者的 6 倍。从 2011 年 1 月 1 日至 6 月 30 日，有 160 例 MSSA 菌血症，每 100 例透析患者中有 1.06 例，有中央静脉导管的患者的风险仍然是 6 倍。
尽管肾中心之间仍存在差异，但接受透析治疗的患者的 MRSA 菌血症总体发生率继续下降。从 MSSA 报告的早期开始，初始数据表明感染率很高，肾中心之间的差异更大。这需要从未来的数据收集得到证实。
