High Risk of Death to Dialysis Patients with Nasal MRSA
By Peter Laird, MD
MRSA is a ubiquitous problem to patients with chronic renal disease, especially in the dialysis center setting. A recent study highlights the extent that colonization with MRSA can impact patient mortality.
Nasal Carriage of Methicillin-resistant Staphylococcus aureus Is Associated with Higher All-Cause Mortality in Hemodialysis Patients
Results We identified 29 MRSA carriers (9.48%) at study entry. After a median of 613 days of follow-up, Kaplan-Meier analysis showed significant survival differences between MRSA carriers and noncarriers (log-rank P = 0.02). Compared with noncarriers, MRSA carriers had a 2.46-fold increased risk of dying from any cause, after adjusting for covariates at the start of follow-up. The adjusted hazard ratios of infection-related mortality and occurrence of subsequent S. aureusinfection in carriers were 4.99 and 4.31, respectively.
Conclusions A major limitation is the relatively small sample size of MRSA carriers. Nevertheless, we demonstrated that there may be an association between MRSA nasal carriage and poor clinical outcomes in an outpatient hemodialysis population. This underscores the need for routine surveillance of MRSA nasal carriage and should alert the physicians of a group at high risk of morbidity and mortality.
Treatment options for nasal MRSA carriage are highly effective and relatively easy to apply. Routine screening for MRSA is not a current practice in the dialysis unit, but the impact that simply having the bacteria in a dialysis patients nose coupled with effective treatment options brings this issue to the forefront of preventable deaths in the dialysis unit. The difficulty of this approach is that many patients in the unit would need to be treated simultaneously as well as the nursing and physician staff members who are likewise at high risk of MRSA colonization. In addition, MRSA nasal carriage recurrence occurs quite frequently. At the very least, adherence to proper hand hygiene could mitigate the spread of MRSA between patients. MRSA will remain a difficult problem for dialysis patients in the foreseeable future.