High Risk of Death to Dialysis Patients with Nasal MRSA

[Hemodoc]

High Risk of Death to Dialysis Patients with Nasal MRSA
By Peter Laird, MD

MRSA is a ubiquitous problem to patients with chronic renal disease, especially in the dialysis center setting.  A recent study highlights the extent that colonization with MRSA can impact patient mortality.

Nasal Carriage of Methicillin-resistant Staphylococcus aureus Is Associated with Higher All-Cause Mortality in Hemodialysis Patients

Results 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. aureusinfection in carriers were 4.99 and 4.31, respectively.

Conclusions 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.

Treatment options for nasal MRSA carriage are highly effective and relatively easy to apply. Routine screening for MRSA is not a current practice in the dialysis unit, but the impact that simply having the bacteria in a dialysis patients nose coupled with effective treatment options brings this issue to the forefront of preventable deaths in the dialysis unit.  The difficulty of this approach is that many patients in the unit would need to be treated simultaneously as well as the nursing and physician staff members who are likewise at high risk of MRSA colonization.  In addition, MRSA nasal carriage recurrence occurs quite frequently. At the very least, adherence to proper hand hygiene could mitigate the spread of MRSA between patients.  MRSA will remain a difficult problem for dialysis patients in the foreseeable future.

http://www.hemodoc.com/2011/01/high-risk-of-death-to-dialysis-patients-with-nasal-mrsa.html

[tyefly]

 I guess we need to have more people wear mask  and gloves...   everyone including the doctors who make the rounds and the heads of staff that just walk around..and vistors.... 

I think private rooms for dialysis would keep down infection....  like they do in hospitals...   

staph a.   is scary.... 

[Hemodoc]

I guess we need to have more people wear mask  and gloves...   everyone including the doctors who make the rounds and the heads of staff that just walk around..and vistors.... 

I think private rooms for dialysis would keep down infection....  like they do in hospitals...   

staph a.   is scary....

Dear Tyefly, the best place to do dialysis is in the comfort of your own home as you already know.  We still have much we know about infection control in dialysis units that is simply overlooked.  Hopefully that culture of benign neglect of infection control issues will pass.

[RichardMEL]

What  are  the  symptoms  of  this  nasal  MRSA?

[Hemodoc]

What  are  the  symptoms  of  this  nasal  MRSA?

It is asymptomatic since it is not an infection, it is colononization of the nasal mucosa.  In other words, it is just a resident of the nose that is waiting for an opportunity to invade an open skin entrance or through contamination directly with dialysis treatments through improper hand hygiene.

[RightSide]

Dear Tyefly, the best place to do dialysis is in the comfort of your own home as you already know. 

Not always.

I'm a bachelor, and I'm not a fastidious housekeeper.
I'm not able to get rid of my carpets because they came with the apartment I'm renting.

Keeping my home as clean as a hospital would be far too much work for me to do while I'm struggling with kidney failure and dialysis at the same time.