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Abstract: FR-PO778

Routine Screening for Staphylococcus aureus in Haemodialysis Patients – Is It Worthwhile?

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Roper, Tayeba, Epsom & St Helier NHS Trust, Surrey, United Kingdom
  • Scuffell, James, Epsom and St Helier University Hospitals NHS Trust, Surrey, United Kingdom
  • Steele, Maggi, Epsom & St Helier NHS Trust, Surrey, United Kingdom
  • Clark, John, St. Helier Hospital, Surrey, United Kingdom
  • Makanjuola, David, St. Helier Hospital, Surrey, United Kingdom
Background

Staphylococcus aureus (S. aureus) is common in haemodialysis (HD) patients, with manifestations varying from asymptomatic colonisation to bacteraemia. This has led to the development of guidelines for routine screening for both methicillin-sensitive and methicillin-resistant S. aureus (MSSA and MRSA). We aimed to establish the effectiveness of screening and de-colonisation for S. aureus in a cohort of HD patients.

Methods

We screened all HD patients at a UK satellite unit between September 2009 and July 2010 for S. aureus carriage. Screening was at 0, 1, 2, 3, 6 and 9 months with nasal, groin and HD line site swabs, cultured on chromogenic agar. Isolates were characterised by antibiogram. Eradication with Chlorhexidine solution was given to all carriers. A further course of eradication therapy was given to those in whom repeat swabs were positive. Due to limited capacity, not all patients with MRSA were isolated in side rooms. Universal precautions were used in all cases. Clinical and demographic data were collected from patient records.

Results

82 patients were included. 68% were male; median age was 68.5 years (range 57-78). 42% were carriers of S. aureus; 80% had MSSA, 20% had MRSA. 15/28 MSSA carriers underwent successful eradication; of these 8/15 re-acquired MSSA. 3/7 MRSA carriers underwent successful eradication, all three re-acquired the same strain of MRSA. MRSA antibiograms were identical in 2/7 patients. These patients dialysed on separate days, making transmission between them unlikely. All other MRSA strains had different antibiograms.

Conclusion

Our data show that S. aureus colonisation is common in HD patients. We found that, despite treatment, eradication is often short-lived or unsuccessful. We believe that S. aureus is often re-acquired from non-clinical areas such as hospital transportation, the home environment and perhaps close relatives/friends. We question the benefit of routinely screening for S. aureus, given the poor de-colonisation and high re-acquisition rates.
The antibiotic resistance profile showed that there was no evidence of cross-transmission within the unit and in the absence of facilities to segregate colonised patients, we have shown that universal infection control measures are sufficient to prevent spread between patients.