Background: Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a well defined risk factor\r\nfor subsequent bacteremia and death in various groups of patients, but its impact on outcome in patients receiving\r\nlong-term hemodialysis (HD) is under debate.\r\nMethods: This prospective interventional cohort study (performed 2004 to 2010) enrolled 289 HD outpatients of an\r\nurban dialysis-unit. Nasal swab cultures for MRSA were performed in all patients upon first admission, at transfer\r\nfrom another dialysis facility or readmission after hospitalisation. Nasal MRSA carriers were treated in a separate\r\nward and received mupirocin nasal ointment. Concomitant extra-nasal MRSA colonization was treated with 0.2%\r\nchlorhexidine mouth rinse (throat) or octenidine dihydrochloride containing antiseptic soaps and 2% chlorhexidine\r\nbody washes (skin). Clinical data and outcome of carriers and noncarriers were systematically analyzed.\r\nResults: The screening approach identified 34 nasal MRSA carriers (11.7%). Extra-nasal MRSA colonization was\r\nobserved in 11/34 (32%) nasal MRSA carriers. History of malignancy and an increased Charlson Comorbidity Index\r\nwere significant predictors for nasal MRSA carriers, whereas traditional risk factors for MRSA colonization or markers\r\nof inflammation or malnutrition were not able to discriminate. Kaplan-Meier analysis demonstrated significant\r\nsurvival differences between MRSA carriers and noncarriers. Mupirocin ointment persistently eliminated nasal MRSA\r\ncolonization in 26/34 (73.5%) patients. Persistent nasal MRSA carriers with failure of this eradication approach had\r\nan extremely poor prognosis with an all-cause mortality rate >85%.\r\nConclusions: Nasal MRSA carriage with failure of mupirocin decolonization was associated with increased mortality\r\ndespite a lack of overt clinical signs of infection. Further studies are needed to demonstrate whether nasal MRSA\r\ncolonization represents a novel predictor of worse outcome or just another surrogate marker of the burden of\r\ncomorbid diseases leading to fatal outcome in HD patients.
Loading....