Invasive methicillin-resistant Staphylococcus aureus infections among patients on chronic dialysis in the United States, 2005-2011

Abstract

Background: Approximately 15 700 invasive methicillin-resistant Staphylococcus aureus (MRSA) infections occurred in US dialysis patients in 2010. Frequent hospital visits and prolonged bloodstream access, especially via central venous catheters (CVCs), are risk factors among hemodialysis patients. We describe the epidemiology of and recent trends in invasive MRSA infections among dialysis patients.

Methods: We analyzed population-based data from 9 US metropolitan areas from 2005 to 2011. Cases were defined as MRSA isolated from a normally sterile body site in a surveillance area resident who received dialysis, and were classified as hospital-onset (HO; culture collected >3 days after hospital admission) or healthcare-associated community-onset (HACO; all others). Incidence was calculated using denominators from the US Renal Data System. Temporal trends in incidence and national estimates were calculated controlling for age, sex, and race.

Results: From 2005 to 2011, 7489 cases were identified; 85.7% were HACO infections, and 93.2% were bloodstream infections. Incidence of invasive MRSA infections decreased from 6.5 to 4.2 per 100 dialysis patients (annual decrease, 7.3%) with annual decreases of 6.7% for HACO and 10.5% for HO cases. Among cases identified during 2009-2011, 70% of patients were hospitalized in the year prior to infection. Among hemodialysis cases, 60.4% of patients were dialyzed through a CVC. The 2011 national estimated number of MRSA infections was 15 169.

Conclusions: There has been a substantial decrease in invasive MRSA infection incidence among dialysis patients. Most cases had previous hospitalizations, suggesting that efforts to control MRSA in hospitals might have contributed to the declines. Infection prevention measures should include improved vascular access and CVC care.

Keywords: dialysis; invasive MRSA; methicillin-resistant S. aureus.

Figure 1.

Rates and modeled yearly changes of invasive methicillin-resistant Staphylococcus aureus infections per 100 dialysis patients by epidemiologic class, Active Bacterial Core surveillance system, 2005–2011. Abbreviations: CI, confidence interval; HACO, healthcare-associated community-onset; HO, hospital-onset; MRSA, methicillin-resistant Staphylococcus aureus.

Figure 2.

Yearly change in invasive MRSA incidence in each surveillance area, 9 Active Bacterial Core surveillance system areas, 2005–2011. Each bar denotes yearly percent change and its 95% confidence interval for each site. The gray bar denotes the change across all sites.