Abstract: FR-PO0437
Risk Factors, Management, and Outcomes of Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia in the Hemodialysis Population in a Singapore Acute Care Hospital
Session Information
- Dialysis: Measuring and Managing Symptoms and Syndromes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Lim, Siow Yu, Tan Tock Seng Hospital, Singapore, Singapore
- Teng, Christine, National University of Singapore, Singapore, Singapore
- Tan, Sock Hoon, Tan Tock Seng Hospital, Singapore, Singapore
- Chuang, Shen Hui, Tan Tock Seng Hospital, Singapore, Singapore
- Bairy, Manohar, Tan Tock Seng Hospital, Singapore, Singapore
Background
Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia (pMRSAB), defined as yielding another positive blood culture more than 1 day after starting culture-directed antibiotics, is associated with high mortality. One risk factor for pMRSAB is kidney failure requiring hemodialysis. However, risk factors and clinical courses in this population are poorly characterized.
The primary objective of this study is to identify risk factors for pMRSAB in hemodialysis patients. Secondary objectives are to compare treatment strategies, treatment characteristics, and outcomes between patients with pMRSAB against those with non-persistent MRSA bacteremia (npMRSAB).
Methods
A retrospective study was conducted between 2013 and 2022 in Tan Tock Seng Hospital, an acute care hospital in Singapore. Patients with MRSA bacteremia were stratified into pMRSAB and npMRSAB. Demographics, clinical characteristics, infection characteristics, and outcomes were collected and analyzed. Risk factors were analyzed using a multivariable logistic regression model.
Results
The study included 187 patients (mean age, 65.7 + 12.1 years) of which 122 were men [62.5%]). Among the study cohort, 92 (49.2%) had pMRSAB. Risk factors for pMRSAB were MRSA colonization (odds ratio [OR] 2.66; 95% confidence interval [CI], 1.07 – 6.57), higher HbA1c among diabetics (OR 1.39; 95% CI, 1.05 – 1.83), higher Pitt Bacteremia score (PBS) (OR 1.33; 95% CI, 1.01 – 1.75), and advanced age (odds ratio 1.04; 95% CI, 1.00 – 1.75). More patients with pMRSAB utilized combination therapy (9/92 [9.8%] vs. 2/95 [2.1%], P <0.05) and received longer treatment (median 30 days [interquartile range (IQR), 18 – 48.8 days] vs. 18 days [IQR, 16 – 41 days], P <0.05). Additionally, those with pMRSAB experienced increased 90-day mortality (36/92 [39.1%] vs. 17/95 [17.9%], P <0.05).
Conclusion
Among hemodialysis patients, pMRSAB portends high mortality. This study identified MRSA colonization, higher HbA1c, higher PBS, and advanced age as risk factors, and these should be addressed where possible. These patients utilized combination therapy more often and had a longer course of treatment.