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Low Yield of Methicillin-Resistant Staphylococcus aureus Screening in Hemodialysis Patients: 10 Years’ Experience

Published online by Cambridge University Press:  26 May 2015

H. M. Gebreselassie ,
T. Kaspar ,
S. Droz  and
J. Marschall
H. M. Gebreselassie
Affiliation:
Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
T. Kaspar
Affiliation:
Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
S. Droz
Affiliation:
Institute for Infectious Diseases, University of Bern, Bern, Switzerland
J. Marschall
Affiliation:
Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
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Abstract

OBJECTIVE

To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in hemodialysis patients and to analyze the cost-effectiveness of our screening approach compared with an alternative strategy.

DESIGN

Screening study and cost-effectiveness analysis.

METHODS

Analysis of twice-yearly MRSA prevalence studies conducted in the hemodialysis unit of a 950-bed tertiary care hospital from January 1, 2004, through December 31, 2013. For this purpose, nasal swab samples were cultured on MRSA screening agar (mannitol-oxacillin biplate).

RESULTS

There were 20 mass screenings during the 10-year study period. We identified 415 patients participating in at least 1 screening, with an average of 4.5 screenings per patient. Of 415 screened patients, 15 (3.6%) were found to be MRSA carriers. The first mass screening in 2004 yielded the highest percentage of MRSA (6/101 [6%]). Only 7 subsequent screenings revealed new MRSA carriers, whereas 4 screenings confirmed previously known carriers, and 8 remained negative. None of the carriers developed MRSA bacteremia during the study period. The total cost of our screening approach, that is, screening and isolation costs, was US $93,930. The total cost of an alternative strategy (ie, no mass screening administered) would be equivalent to costs of isolation of index cases and contact tracing was estimated to be US $5,382 (difference, US $88,548).

CONCLUSIONS

In an area of low MRSA endemicity (<5%), regular nasal screenings of a high-risk population yielded a low rate of MRSA carriers. Twice-yearly MRSA screening of dialysis patients is unlikely to be cost-effective if MRSA prevalence is low.

Infect. Control Hosp. Epidemiol. 2015;36(9):1046–1049

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 9 , September 2015 , pp. 1046 - 1049
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

1. BC Provincial Renal Agency. Approach to managing antibiotic resistant organisms (AROs) in British Columbia hemodialysis units. http://www.bcrenalagency.ca/sites/default/files/documents/files/BCPR-position-paper-AROs-hemodialysis-FINAL.pdf. Updated June 2009.Google Scholar
2. Parker, MG, Doebbeling, BN. The challenge of methicillin-resistant Staphylococcus aureus prevention in hemodialysis therapy. Semin Dial 2012;25:42–49.Google Scholar
3. Kang, YC, Tai, WC, Yu, CC, Kang, JH, Huang, YC. Methicillin-resistant Staphylococcus aureus nasal carriage among patients receiving hemodialysis in Taiwan: prevalence rate, molecular characterization and de-colonization. BMC Infect Dis 2012;12:284.Google Scholar
4. Tacconelli, E, Carmeli, Y, Aizer, A, Ferreira, G, Foreman, MG, D’Agata, EMC. Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: a meta-analysis. Clin Infect Dis 2003;37:1629–1638.Google Scholar
5. Zacharioudakis, IM, Zervou, FN, Ziakas, PD, Mylonakis, E. Meta-analysis of methicillin-resistant Staphylococcus aureus colonization and risk of infection in dialysis patients. J Am Soc Nephrol 2014;25:2131–2141.Google Scholar
6. Lai, CF, Liao, CH, Pai, MF, 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;6:167–174.Google Scholar
7. Bühlmann, M, Bögli-Stuber, K, Droz, S, Mühlemann, K. Rapid screening for carriage of methicillin-resistant Staphylococcus aureus by PCR and associated costs. J Clin Microbiol 2008;46:2151–2154.Google Scholar
8. Huang, SS, Hinrichsen, VL, Datta, R, et al. Methicillin-resistant Staphylococcus aureus infection and hospitalization in high-risk patients in the year following detection. PLOS ONE 2011;6:e24340.Google Scholar
9. Filice, GA, Nyman, JA, Lexau, C, et al. Excess costs and utilization associated with methicillin resistance for patients with Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2010;31:365–373.Google Scholar
10. Senn, L, Basset, P, Greub, G, et al. Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Switzerland: sampling only invasive isolates does not allow a representative description of the local diversity of clones. Clin Microbiol Infect 2013;19:E288–E290.Google Scholar
11. McCann, M, Moore, ZE. Interventions for preventing infectious complications in haemodialysis patients with central venous catheters. Cochrane Database Syst Rev 2010:CD006894.Google Scholar
12. Lederer, SR, Riedelsdorf, G, Schiffl, H. Nasal carriage of meticillin resistant Staphylococcus aureus: the prevalence, patients at risk and the effect of elimination on outcomes among outclinic haemodialysis patients. Eur J Med Res 2007;127:284–288.Google Scholar
13. Resić, H, Corić, A, Dedeić-Ljubović, A, Hukić, M, Avdić, E, Kukavica, N. Prevalence of MRSA infections in patients on hemodialysis [article in Serbian]. Med Pregl 2007;60:97–100.Google Scholar
14. Dantes, R, Mu, Y, Belflower, R, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med 2013;173:1970–1978.Google Scholar
15. Marschall, J, Mühlemann, K. Duration of methicillin-resistant Staphylococcus aureus carriage, according to risk factors for acquisition. Infect Control Hosp Epidemiol 2006;27:1206–1212.Google Scholar
16. Tübbicke, A, Hübner, C, Hübner, N-O, Wegner, C, Kramer, A, Fleßa, S. Cost comparison of MRSA screening and management—a decision tree analysis. BMC Health Serv Res 2012;12:438.Google Scholar
17. Witteck, A, Rettenmund, G, Schlegel, M. MRSA admission screening in a low prevalence setting—much ado about nothing? Swiss Med Wkly 2011;141:w13217.Google Scholar
18. Price, A, Sarween, N, Gupta, I, Baharani, J. Meticillin-resistant Staphylococcus aureus and meticillin-susceptible Staphylococcus aureus screening in a cohort of haemodialysis patients: carriage, demographics and outcomes. J Hosp Infect 2015;90:22–27.Google Scholar
19. Kohler, P, Bregenzer-Witteck, A, Rettenmund, G, Otterbech, S, Schlegel, M. MRSA decolonization: success rate, risk factors for failure and optimal duration of follow-up. Infection 2013;41:33–40.CrossRefGoogle ScholarPubMed