Korean J Nosocomial Infect Control.  2013 Dec;18(2):51-56. 10.14192/kjnic.2013.18.2.51.

Nasal Colonization and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus among Hemodialysis Patients in 7 Korean Hospitals

• Kim JS
• Lee SH
• Jeong J
• Roh KH
• Lee HK
• Jang SJ
• Lee HS
• Kim JU
• Lee SH
• Yeom JS
• Lee SO
• Choi JS
• Yoo SY
• Jeong JS
• Kim MN

• KMID: 2256308
• DOI: http://doi.org/10.14192/kjnic.2013.18.2.51

Abstract

BACKGROUND
Staphylococcus aureus is a major bacteremia-causing pathogen in hemodialysis patients, frequently colonizing patient skin and mucosa. Active infection control is necessary to prevent methicillin-resistant S. aureus (MRSA) infection in hospitals; however, the spread of community-associated MRSA has recently become a concern for MRSA infection control. We evaluated the nasal colonization of MRSA among hemodialysis patients and the molecular characterization of the MRSA isolates.
METHODS
Nasal swabs were obtained from 482 hemodialysis patients in 7 nationwide hospitals in November 2009, and cultured for MRSA colonization. Swabs were inoculated and cultured in 6.5% NaCl tryptic soy broth, then subcultured on MRSASelect medium (Bio-Rad, Hercules, CA) for 20-24 h. Multiplex PCR was performed to analyze staphylococcal cassette chromosome mec (SCCmec) types of MRSA isolates.
RESULTS
Of 482 hemodialysis patients, 57 (11.8%) carried MRSA, ranging from 6.7% to 19.0%. Among the 57 MRSA isolates, we identified 3 (5.3%) SCCmec II, 1 (1.8%) SCCmec IIA, 30 (52.6%) SCCmec IIB, 1 (1.8%) SCCmec III, 6 (10.5%) SCCmec IV, and 16 (28.1%) SCCmec IVA subtypes.
CONCLUSION
The MRSA carriage rate (11.8%) of hemodialysis patients in this study was high. The SCCmec IIB subtype, a healthcare-associated strain, was the predominant strain, although SCCmec IV isolates, typically found in community-associated MRSA infections, were also frequently observed. To prevent healthcare-associated MRSA infections in hemodialysis patients, standardized infection control measures should be performed, and efforts to reduce MRSA carriage rates should be considered.

Keyword

Colonization; Dialysis unit; Hemodialysis; Infection control; MRSA; Staphylococcus aureus

MeSH Terms

Colon*
Humans
Infection Control
Methicillin Resistance*
Methicillin-Resistant Staphylococcus aureus*
Mucous Membrane
Multiplex Polymerase Chain Reaction
Renal Dialysis*
Skin
Staphylococcus aureus

Reference

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