Methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia in haemodialysis patients

Background: The aim of the study was to determine clinical and microbiological differences between patients with methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia (CRB) undergoing or not undergoing haemodialysis, and to compare outcomes. Methods: Prospective multicentre...

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Authors: Cuervo, Guillermo|||0000-0002-7075-943X, Camoez, Mariana, Shaw, Evelyn|||0000-0002-1882-1259, Domínguez, M. Angeles|||0000-0003-3107-9586, Gasch Blasi, Oriol|||0000-0001-8518-458X, Padilla Ortega, Belén, Pintado, Vicente, Almirante Gragera, Benito|||0000-0002-1189-2361, Molina, José, López-Medrano, Francisco, Ruiz de Gopegui, Enrique, Martinez Martinez, Jose Antonio|||0000-0002-7012-9817, Bereciartua, Elena|||0000-0002-8603-779X, Rodriguez-Lopez, Fernando, Fernandez-Mazarrasa, Carlos, Goenaga, Miguel Ángel, Benito, Natividad|||0000-0001-6410-013X, Rodríguez-Baño, Jesús|||0000-0001-6732-9001, Espejo, Elena|||0000-0001-9018-7515, Pujol, Miquel|||0000-0002-6475-6208, Jover-Saenz, Alfredo|||0000-0001-5207-7200, Barcenilla, Fernando, Dueñas, Carlos, Ojeda, Eva, Marco, Francesc|||0000-0002-1863-6379, Chaves Sánchez, Fernando, Lagarde, María, Montejo Baranda, Jose Miguel|||0000-0001-7432-0830, Hernández, José Luís, Von Wichmann, Miguel Ángel, García-Arenzana, José María, Padilla, Camilo, Cercenado, Emilia|||0000-0002-5279-3773, García-Pardo, Graciano|||0000-0003-0274-6001, Tapiol, Josepa, Horcajada, Juan Pablo|||0000-0001-9873-5459, Montero, María Milagro|||0000-0001-5991-6804, Salvadó, Margarita, Arnaiz-Garcia, Ana María|||0000-0003-3415-8511, Fernández, Carmen, Calbo Sebastián, Esther|||0000-0001-7750-5347, Xercavins, M.|||0000-0003-1463-6344, Granados-Maturano, Ana|||0000-0002-5323-5909, Fontanals, Dionísia|||0000-0002-2994-6065, Loza, Elena, Torre-Cisneros, Julián, Lara, Rosario, Rodríguez, Marina, Nátera, Clara, Blanco, José Ramón|||0000-0002-4268-0150, Olarte, Inés, Mirelis, Beatriz, Murillas, Javier|||0000-0003-2169-7110, López, Erick Daniel, Pascual Hernández, Álvaro|||0000-0002-8672-5891, Martín, Carlos, Lepe, Jose A.|||0000-0002-3635-4930, Sordé Masip, Roger|||0000-0002-0492-7327, Larrosa, María Nieves|||0000-0001-8808-0233, Morera, María Antònia
Format: article
Publication Date:2015
Country:España
Institution:Universitat Autònoma de Barcelona
Repository:Dipòsit Digital de Documents de la UAB
Language:English
OAI Identifier:oai:ddd.uab.cat:296534
Online Access:https://ddd.uab.cat/record/296534
https://dx.doi.org/urn:doi:10.1186/s12879-015-1227-y
Access Level:Open access
Keyword:Bacteraemia
Catheter-related
Haemodialysis
MRSA
Description
Summary:Background: The aim of the study was to determine clinical and microbiological differences between patients with methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia (CRB) undergoing or not undergoing haemodialysis, and to compare outcomes. Methods: Prospective multicentre study conducted at 21 Spanish hospitals of patients with MRSA bacteraemia diagnosed between June 2008 and December 2009. Patients with MRSA-CRB were selected. Data of patients on haemodialysis (HD-CRB) and those not on haemodialysis (non-HD-CRB) were compared. Results: Among 579 episodes of MRSA bacteraemia, 218 (37.7 %) were CRB. Thirty-four (15.6 %) were HD-CRB and 184 (84.4 %) non-HD-CRB. All HD-CRB patients acquired the infection at dialysis centres, while in 85.3 % of the non-HD-CRB group the infection was nosocomial (p <.001). There were no differences in age, gender or severity of bacteraemia (Pitt score); comorbidities (Charlson score ≥ 4) were higher in the HD-CRB group than in the non-HD-CRB group (73.5 % vs. 46.2 %, p =.003). Although there were no differences in VAN-MIC ≥1.5 mg/L according to microdilution, using the E-test a higher rate of VAN-MIC ≥1.5 mg/L was observed in HD-CRB than in non-HD-CRB patients (63.3 % vs. 44.1 %, p =.051). Vancomycin was more frequently administered in the HD-CRB group than in the non-HD-CRB group (82.3 % vs. 42.4 %, p = <.001) and therefore the appropriate empirical therapy was significantly higher in HD-CRB group (91.2 % vs. 73.9 %, p =.029). There were no differences with regard to catheter removal (79.4 % vs. 84.2 %, p =.555, respectively). No significant differences in mortality rate were observed between both groups (Overall mortality: 11.8 % vs. 27.2 %, p =.081, respectively), but there was a trend towards a higher recurrence rate in HD-CRB group (8.8 % vs. 2.2 %, p =.076). Conclusions: In our multicentre study, ambulatory patients in chronic haemodialysis represented a significant proportion of cases of MRSA catheter-related bacteraemia. Although haemodialysis patients with MRSA catheter-related bacteraemia had significantly more comorbidities and higher proportion of strains with reduced vancomycin susceptibility than non-haemodialysis patients, overall mortality between both groups was similar.

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