Methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia in haemodialysis patients
Por:
Cuervo, G, Camoez, M, Shaw, E, Dominguez, MA, Gasch, O, Padilla, B, Pintado, V, Almirante, B, Molina, J, Lopez-Medrano, F, de Gopegui, ER, Martinez, JA, Bereciartua, E, Rodriguez-Lopez, F, Fernandez-Mazarrasa, C, Goenaga, MA, Benito, N, Rodriguez-Bano, J, Espejo, E, Pujol, M
Publicada:
30 oct 2015
Resumen:
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.
Filiaciones:
Cuervo, G:
Hosp Univ Bellvitge, Dept Infect Dis, Barcelona 08907, Spain
Camoez, M:
Bellvitge Hosp, Dept Microbiol, Barcelona, Spain
Shaw, E:
Hosp Univ Bellvitge, Dept Infect Dis, Barcelona 08907, Spain
Dominguez, MA:
Bellvitge Hosp, Dept Microbiol, Barcelona, Spain
Gasch, O:
Hosp Parc Tauli, Dept Infect Dis, Sabadell, Spain
Padilla, B:
Hosp Gen Gregorio Maranon, Dept Infect Dis, Madrid, Spain
Pintado, V:
Hosp Ramon & Cajal, Dept Infect Dis, E-28034 Madrid, Spain
Almirante, B:
Hosp Valle De Hebron, Dept Infect Dis, Barcelona, Spain
Molina, J:
Hosp Virgen del Rocio, Dept Infect Dis, Seville, Spain
Lopez-Medrano, F:
Hosp 12 Octubre, Dept Infect Dis, E-28041 Madrid, Spain
de Gopegui, ER:
Hosp Son Espases, Dept Microbiol, Palma de Mallorca, Spain
Martinez, JA:
Hosp Clin Barcelona, Dept Infect Dis, Barcelona, Spain
Bereciartua, E:
Hosp Cruces, Dept Infect Dis, Bilbao, Spain
Rodriguez-Lopez, F:
Hosp Reina Sofia, Dept Infect Dis, Cordoba, Spain
Fernandez-Mazarrasa, C:
Hosp Marques de Valdecilla, Dept Microbiol, Santander, Spain
Goenaga, MA:
Hosp Donostia, Dept Infect Dis, Donostia San Sebastian, Spain
Benito, N:
Hosp Santa Creu & Sant Pau, Dept Infect Dis, Barcelona, Spain
Rodriguez-Bano, J:
Hosp Virgen Macarena, Dept Infect Dis, Seville, Spain
Espejo, E:
Hosp Terrassa, Dept Infect Dis, Terrassa, Spain
Pujol, M:
Hosp Univ Bellvitge, Dept Infect Dis, Barcelona 08907, Spain
Gold, Green Published
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