TY - JOUR
T1 - Methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia in haemodialysis patients
AU - Cuervo, Guillermo
AU - Camoez, Mariana
AU - Shaw, Evelyn
AU - Dominguez, María Ángeles
AU - Gasch, Oriol
AU - Padilla, Belén
AU - Pintado, Vicente
AU - Almirante, Benito
AU - López-Medrano, Francisco
AU - De Gopegui, Enrique Ruiz
AU - Martinez, José A.
AU - Bereciartua, Elena
AU - Rodriguez-Lopez, Fernando
AU - Fernandez-Mazarrasa, Carlos
AU - Goenaga, Miguel Ángel
AU - Benito, Natividad
AU - Rodríguez-Baño, Jesús
AU - Espejo, Elena
AU - Pujol, Miquel
AU - Jover, A.
AU - Barcenilla, F.
AU - Garcia, M.
AU - Ojeda, E.
AU - Marco, F.
AU - Chaves, F.
AU - Lagarde, M.
AU - Montejo, J. M.
AU - Hernández, J. L.
AU - Von Wichmann, M. A.
AU - García-Arenzana, J. M.
AU - Padilla, C.
AU - Cercenado, E.
AU - García-Pardo, G.
AU - Tapiol, J.
AU - Horcajada, J. P.
AU - Montero, M.
AU - Salvado, M.
AU - Arnáiz, A.
AU - Fernandez, C.
AU - Calbo, E.
AU - Xercavins, M.
AU - Granados, A.
AU - Fontanals, D.
AU - Loza, E.
AU - Torre-Cisneros, J.
AU - Lara, R.
AU - Rodríguez, M.
AU - Natera, C.
AU - Blanco, J. R.
N1 - Funding Information:
B. A. has received funding for research from Pfizer, Novartis, Gilead and MSD, and funds for advisory board membership from Pfizer, Gilead, Novartis, Janssen, Astellas and MSD. N. B. has received funding for speaking, consultancy, advisory board membership and travel from MSD, Pfizer, Gilead, Novartis and AstraZeneca. J. R.-B. has received funding for research from Novartis, has served as speaker for Astellas, Merck, Astra-Zeneca and Pfizer, and has been a consultant for Roche, Novartis and Janssen. All other authors: none to declare.
Funding Information:
This study was supported by Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III (FIS 08/0335) and co-financed by the European Development Regional Fund ‘A way to achieve Europe’ ERDF, Spanish Network for Research in Infectious Diseases (REIPI RD06/0008). O. G. was recipient of a Río Hortega Grant (CM08/228) from the Instituto de Salud Carlos III.
Publisher Copyright:
© 2015 Cuervo et al.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2015/10/30
Y1 - 2015/10/30
N2 - 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.
AB - 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.
KW - Bacteraemia
KW - Catheter-related
KW - Haemodialysis
KW - MRSA
UR - http://www.scopus.com/inward/record.url?scp=84945907463&partnerID=8YFLogxK
U2 - 10.1186/s12879-015-1227-y
DO - 10.1186/s12879-015-1227-y
M3 - Article
C2 - 26518487
AN - SCOPUS:84945907463
SN - 1471-2334
VL - 15
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
IS - 1
M1 - 484
ER -