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Title: Methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia in haemodialysis patients
Author: Cuervo Requena, Guillermo
Camoez, Mariana
Shaw Perujo, Evelyn
Domínguez Luzón, Ma. Ángeles (María Ángeles)
Gasch, Oriol
Padilla, Belén
Pintado, Vicente
Almirante, Benito
Molina, José
López-Medrano, Francisco
Ruiz de Gopegui, Enrique
Martínez Martínez, José Antonio
Bereciartua, Elena
Rodriguez-Lopez, Fernando
Fernandez-Mazarrasa, Carlos
Goenaga, Miguel Ángel
Benito Hernández, M. Natividad de
Rodríguez-Baño, Jesús
Espejo, Elena
Pujol Rojo, Miquel
REIPI (Spanish Network for Research in Infectious)
GEIH (Hospital Infection Study Group)
Keywords: Staphylococcus aureus
Staphylococcus aureus
Issue Date: 30-Oct-2015
Publisher: BioMed Central
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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It is part of: Bmc Infectious Diseases, 2015, vol. 15, p. 484
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ISSN: 1471-2334
Appears in Collections:Articles publicats en revistes (Medicina)
Articles publicats en revistes (Patologia i Terapèutica Experimental)

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