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An Outbreak of Methicillin-Resistant Staphylococcus aureus Infections Related to Central Venous Catheters for Hemodialysis

Published online by Cambridge University Press:  02 January 2015

Sai-Cheong Lee*
Affiliation:
Division of Infectious Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
Kuo-Su Chen
Affiliation:
Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
Chi-Jen Tsai
Affiliation:
Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
Ching-Chang Lee
Affiliation:
Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
Hung Yu Chang
Affiliation:
Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
Lai-Chu See
Affiliation:
Department of Public Health, Chang Gung University, Linkou, Taiwan, Republic of China
Yu-Chin Kao
Affiliation:
Division of Infectious Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
Shu-Chu Chen
Affiliation:
Division of Infectious Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
Cheng-Hsu Wang
Affiliation:
Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
*
Division of Infectious Diseases, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taiwan, Republic of China

Abstract

Objectives:

To determine risk factors for hemodialysis catheter-related bloodstream infections (HCRBSIs) and investigate whether use of maximal sterile barrier precautions would prevent HCRBSIs.

Setting:

Tertiary-care medical center hemodialysis unit.

Design:

Open trial with historical comparison and case-control study of risk factors for HCRBSIs.

Methods:

Prospective surveillance was used to compare HCRBSI rates for 1 year before and after implementation of maximal sterile barrier precautions. A case–control study compared 50 case-patients with HCRBSI with 51 randomly selected control-patients.

Results:

The HCRBSI rate was 1.6% per 100 dialysis runs (CI95, 1.1%–2.3%) in the first year and 0.77% (CI95, 0.5%–1.1%) in the second year (P = .0106). The most frequent cause of HCRBSI was MRSA in the first year (15 of 32) and MSSA in the second year (13 of 18). Ten MRSA blood isolates in the first year were identical by PFGE. Diabetes mellitus was a risk factor for HCRBSI. Age, gender, site of hemodialysis central venous catheter (CVC), other underlying diseases, coma score, APACHE II score, serum albumin level, and cholesterol level were not associated with HCRBSI and did not change between the 2 years. Hospital stay was prolonged for case-patients (32.78 ± 20.96 days) versus control-patients (22.75 ± 17.33 days), but mortality did not differ.

Conclusions:

Use of maximal sterile barrier precautions during the insertion of CVCs reduced HCRBSIs in dialysis patients and seemed cost-effective. Diabetes mellitus was associated with HCRBSI. An outbreak of MRSA in the first year was likely caused by cross-infection via medical personnel.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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