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Clinical and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus among Patients in an Ambulatory Hemodialysis Center

  • Gopi Patel (a1), Stephen G. Jenkins (a2), José R. Mediavilla (a3), Barry N. Kreiswirth (a3), Brian Radbill (a1), Cassandra D. Salgado (a4) and David P. Calfee (a1) (a5)...



To describe the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) carriage and transmission in an ambulatory hemodialysis population.


Prospective cohort study.


Outpatient hemodialysis facility affiliated with a large academic medical center.


Of the 170 facility patients, 103 (61%) participated in the study.


Swab specimens of the nares, axillae, and vascular access site were collected from participants weekly for 3 weeks and then monthly for 5 months. Demographic and clinical data were collected monthly for 12 months. Molecular analysis of MRSA isolates was performed.


The baseline MRSA carriage prevalence was 12%. Factors associated with MRSA carriage included a history of MRSA; failed renal transplantation; hospital admission within 6 months; and receipt of a first-generation cephalosporin, cefepime, or vancomycin. Six subjects acquired MRSA after enrollment (incidence, 1.2 per 100 patient-months at-risk; overall prevalence, 18%). Molecular analysis suggested that transmission occurred within the facility. The incidence of MRSA infection among carriers was 1.76 per 100 patient-months. Community-associated strains (ie, USA300) were isolated from 28% of carriers and at least 25% of infections.


The prevalence of MRSA carriage and the incidence of infection among carriers were high among ambulatory hemodialysis patients, and community-associated MRSA was responsible for a large portion of the MRSA burden. A relatively high rate of MRSA acquisition was observed, with indirect evidence of intrafacility transmission. Additional studies are needed to confirm these findings and to identify effective and feasible methods to prevent MRSA transmission and infection among hemodialysis patients.


Corresponding author

MS Weill Cornell Medical College, 525 East 68th Street, Box 576, New York, NY 10021 (


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1.US Renal Data System. USRDS 2010 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, 2010. Accessed December 9, 2010.
2.Tokars, JI, Miller, ER, Stein, G. New national surveillance system for hemodialysis-associated infections: initial results. Am J Infect Control 2002;30(5):288295.
3.Reed, S, Friedman, J, Engemann, J, et al.Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 2005;26(2):175183.
4.Centers for Disease Control and Prevention. Invasive methicillin-resistant Staphylococcus aureus infections among dialysis patients: United States, 2005. MMWR Morb Mortal Wkly Rpt 2007;56(9):197199.
5.Herwaldt, LA. Reduction of Staphylococcus aureus nasal carriage and infection in dialysis patients. J Hosp Infect 1998;40(suppl B):S13S23.
6.Yu, VL, Goetz, A, Wagener, M, et al.Staphylococcus aureus nasal carriage and infection in patients on hemodialysis: efficacy of antibiotic prophylaxis. N Engl J Med 1986;315(2):9196.
7.Lu, P, Tsai, J, Chiu, Y, et al.Methicillin-resistant Staphylococcus aureus carriage, infection and transmission in dialysis patients, healthcare workers and their family members. Nephrol Dial Transplant 2008;23(5):16591665.
8.Hadley, A, Karchmer, T, Russell, G, McBride, D, Freedman, B. The prevalence of resistant bacterial colonization in chronic hemodialysis patients. Am J Nephrol 2007;27(4):352359.
9.Eguia, J, Liu, C, Moore, M, et al.Low colonization prevalence of Staphylococcus aureus with reduced vancomycin susceptibility among patients undergoing hemodialysis in the San Francisco Bay area. Clin Infect Dis 2005;40(11):16171624.
10.Resić, H, Corić, A, Dedeic-Ljubovic, A, Hukić, M, Avdić, E, Ku-kavica, N. Prevalence of MRSA infections in patients on hemodialysis. Med Pregi 2007;60(suppl 2):97100.
11.Mountricha, A, Platsouka, E, Pappas, C, et al.S. aureus nasal carriage among hemodialysis (HD) patients. Clin Nephrol 2006;65(3):229230.
12.Duran, N, Ocak, S, Eskiocak, A. Staphylococcus aureus nasal carriage among the diabetic and non-diabetic haemodialysis patients. Int J Clin Pract 2006;60(10):12041209.
13.Ghasemian, R, Najafi, N, Makhlough, A, Khademloo, M. Frequency of nasal carriage of Staphylococcus aureus and its antimicrobial resistance pattern in patients on hemodialysis. Iran J Kidney Dis 2010;4(3):218222.
14.Lai, C, Liao, C, Pai, M, et al.Nasal carriage of methicillin-resistant Staphylococcus aureus is associated with higher all-cause mortality in hemodialysis patients. Clin J Am Soc Nephrol 2011;6(1):167174.
15.Mermel, L, Eells, S, Acharya, M, et al.Quantitative analysis and molecular fingerprinting of methicillin-resistant Staphylococcus aureus nasal colonization in different patient populations: a prospective, multicenter study. Infect Control Hosp Epidemiol 2010;31(6):592597.
16.Maree, C, Daum, R, Boyle-Vavra, S, Matayoshi, K, Miller, L. Community-associated methicillin-resistant Staphylococcus aureus isolates and healthcare-associated infections. Emerg Infect Dis 2007;13:236242.
17.Popovich, KJ, Weinstein, RA, Hota, B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 2008;46(6):787794.
18.Jenkins, TC, McCollister, BD, Sharma, R, et al.Epidemiology of healthcare-associated bloodstream infection caused by USA300 strains of methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Infect Control Hosp Epidemiol 2009;30(3):233241.
19.Johnson, L, Venugopal, A, Pawlak, J, Saravolatz, L. Emergence of community-associated methicillin-resistant Staphylococcus aureus infection among patients with end-stage renal disease. Infect Control Hosp Epidemiol 2006;27(10):10571062.
20.Johnson, L, Jose, J, Yousif, F, Pawlak, J, Saravolatz, L. Prevalence of colonization with community-associated methicillin-resistant Staphylococcus aureus among end-stage renal disease patients and healthcare workers. Infect Control Hosp Epidemiol 2009;30(1):48.
21.Centers for Disease Control and Prevention. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep 2001;50(RR-5):143.
22.Nouwen, J, Ott, A, Kluytmans-Vandenbergh, M, et al.Predicting the Staphylococcus aureus nasal carrier state: derivation and validation of a “culture rule.” Clin Infect Dis 2004;39(6):806811.
23.Horan, T, Andrus, M, Dudeck, M. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.
24.Centers for Disease Control and Prevention. National Healthcare Safety Network: Device-Associated Module, Dialysis Event. Atlanta, GA: CDC, 2010. Accessed April 14, 2011.
25.Mathema, B, Mediavilla, J, Kreiswirth, BN. Sequence analysis of the variable number tandem repeat in Staphylococcus aureus protein A gene: spa typing. Methods Mol Biol 2008;431:285305.
26.Shopsin, B, Gomez, M, Montgomery, SO, et al.Evaluation of protein A gene polymorphic region DNA sequencing for typing of Staphylococcus aureus strains. J Clin Microbiol 1999;37(11):35563563.
27.Chen, L, Mediavilla, JR, Oliveira, DC, Willey, BM, de Lencastre, H, Kreiswirth, BN. Multiplex real-time PCR for rapid staphylococcal cassette chromosome mec typing. J Clin Microbiol 2009;47(11):36923706.
28.Strommenger, B, Kettlitz, C, Weniger, T, Harmsen, D, Friedrich, AW, Witte, W. Assignment of Staphylococcus isolates to groups by spa typing, Smal macrorestriction analysis, and multilocus sequence typing. J Clin Microbiol 2006;44(7):25332540.
29.Tenover, F, Arbeit, R, Goering, R, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33(9):22332239.
30.Herwaldt, L, Boyken, L, Coffman, S, Hochstetler, L, Flanigan, M. Sources of Staphylococcus aureus for patients on continuous ambulatory peritoneal dialysis. Perir Dial Int 2003;23(3):237241.
31.Lautenbach, E, Nachamkin, I, Hu, B, et al.Surveillance cultures for detection of methicillin-resistant Staphylococcus aureus: diagnostic yield of anatomic sites and comparison of provider-and patient-collected samples. Infect Control Hosp Epidemiol 2009;30(4):380382.

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Clinical and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus among Patients in an Ambulatory Hemodialysis Center

  • Gopi Patel (a1), Stephen G. Jenkins (a2), José R. Mediavilla (a3), Barry N. Kreiswirth (a3), Brian Radbill (a1), Cassandra D. Salgado (a4) and David P. Calfee (a1) (a5)...


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