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Observational Study
. 2015 Oct 30:15:484.
doi: 10.1186/s12879-015-1227-y.

Methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia in haemodialysis patients

Guillermo Cuervo  1 , Mariana Camoez  2 , Evelyn Shaw  3 , María Ángeles Dominguez  4 , Oriol Gasch  5 , Belén Padilla  6 , Vicente Pintado  7 , Benito Almirante  8 , José Molina  9 , Francisco López-Medrano  10 , Enrique Ruiz de Gopegui  11 , José A Martinez  12 , Elena Bereciartua  13 , Fernando Rodriguez-Lopez  14 , Carlos Fernandez-Mazarrasa  15 , Miguel Ángel Goenaga  16 , Natividad Benito  17 , Jesús Rodriguez-Baño  18 , Elena Espejo  19 , Miquel Pujol  20 ; REIPI/GEIH Study Group
Collaborators, Affiliations
Observational Study

Methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia in haemodialysis patients

Guillermo Cuervo et al. BMC Infect Dis. .

Abstract

Background: The aim of the study was to determine clinical and microbiological differences between patients with methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia (CRB) undergoing or not undergoing haemodialysis, and to compare outcomes.

Methods: Prospective multicentre study conducted at 21 Spanish hospitals of patients with MRSA bacteraemia diagnosed between June 2008 and December 2009. Patients with MRSA-CRB were selected. Data of patients on haemodialysis (HD-CRB) and those not on haemodialysis (non-HD-CRB) were compared.

Results: Among 579 episodes of MRSA bacteraemia, 218 (37.7%) were CRB. Thirty-four (15.6%) were HD-CRB and 184 (84.4%) non-HD-CRB. All HD-CRB patients acquired the infection at dialysis centres, while in 85.3% of the non-HD-CRB group the infection was nosocomial (p < .001). There were no differences in age, gender or severity of bacteraemia (Pitt score); comorbidities (Charlson score ≥ 4) were higher in the HD-CRB group than in the non-HD-CRB group (73.5% vs. 46.2%, p = .003). Although there were no differences in VAN-MIC ≥ 1.5 mg/L according to microdilution, using the E-test a higher rate of VAN-MIC ≥ 1.5 mg/L was observed in HD-CRB than in non-HD-CRB patients (63.3% vs. 44.1%, p = .051). Vancomycin was more frequently administered in the HD-CRB group than in the non-HD-CRB group (82.3% vs. 42.4%, p = <.001) and therefore the appropriate empirical therapy was significantly higher in HD-CRB group (91.2% vs. 73.9%, p = .029). There were no differences with regard to catheter removal (79.4% vs. 84.2%, p = .555, respectively). No significant differences in mortality rate were observed between both groups (Overall mortality: 11.8% vs. 27.2%, p = .081, respectively), but there was a trend towards a higher recurrence rate in HD-CRB group (8.8% vs. 2.2%, p = .076).

Conclusions: In our multicentre study, ambulatory patients in chronic haemodialysis represented a significant proportion of cases of MRSA catheter-related bacteraemia. Although haemodialysis patients with MRSA catheter-related bacteraemia had significantly more comorbidities and higher proportion of strains with reduced vancomycin susceptibility than non-haemodialysis patients, overall mortality between both groups was similar.

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Figures

Fig. 1
Fig. 1
Flow chart of patients included in analysis
See this image and copyright information in PMC

References

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