Influence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage on MRSA bloodstream infections among patients on chronic hemodialysis

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"es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Panorama epidemiológico de la insuficiencia renal crónica en el segundo nivel de atención del Instituto Mexicano del Seguro Social" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "148" "paginaFinal" => "156" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Epidemiological overview of chronic renal failure in the second level of attention of the Mexican Institute of Social Security" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figura 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ 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"en" => array:1 [ "titulo" => "Cost-effectiveness analysis of return to peritoneal dialysis of patients previously on hemodialysis" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Antonio Méndez-Durán, María Ivonne Téllez-Barrientos" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Antonio" "apellidos" => "Méndez-Durán" ] 1 => array:2 [ "nombre" => "María Ivonne" "apellidos" => "Téllez-Barrientos" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1886284514001556?idApp=UINPBA00004N" "url" => "/18862845/0000003500000004/v1_201412182338/S1886284514001556/v1_201412182338/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Influence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage on MRSA bloodstream infections among patients on chronic hemodialysis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "143" "paginaFinal" => "147" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.V. Sathish, Pavan Malleshappa, M.K. Yashaswini, Sulaiman Shariff" "autores" => array:4 [ 0 => array:3 [ "nombre" => "J.V." "apellidos" => "Sathish" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Pavan" "apellidos" => "Malleshappa" "email" => array:1 [ 0 => "dr_pavanm@yahoo.co.in" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "M.K." "apellidos" => "Yashaswini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Sulaiman" "apellidos" => "Shariff" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Microbiology, Adichunchanagiri Institute of Medical Sciences, B. G. Nagara, Karnataka, India" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Division of Nephrology, Department of Medicine, Adichunchanagiri Institute of Medical Sciences, B. G. Nagara, Karnataka, India" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Influencia del estado de portador nasal de Staphylococcus aureus resistente a meticilina (MRSA) en las infecciones hemáticas por MRSA en pacientes en hemodiálisis crónica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1389 "Ancho" => 1553 "Tamanyo" => 82782 ] ] "descripcion" => array:1 [ "en" => "S. aureus nasal carriage among hemodialysis patients." ] ] ] "textoCompleto" => "IntroductionS. aureus is a ubiquitous microorganism in both healthy and compromised hosts. The anterior nares have been shown to be the main reservoir of S. aureus in adults.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> It has been proposed that approximately10–50% of adults were colonized with S. aureus.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> Nasal carriage of S. aureus has been demonstrated to be a significant risk factor for nosocomial and community-acquired infection in various populations. Self-inoculation occurs when organisms from the nose colonize other areas of the skin leading to infection. Studies have found that nasal colonization with methicillin-resistant S. aureus (MRSA) poses an increased risk of infection. MRSA strains are resistant to several groups of broad-spectrum antibiotics.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> This mechanism of increased spreading under antibiotic pressure may contribute to the worldwide increase in the prevalence of MRSA in hospitals. Hemodialysis patients are particularly vulnerable to staphylococcal colonization as well as infections.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Little is known about the prevalence of MRSA among hemodialysis patients in India. The purpose of this study was to determine the prevalence of MRSA nasal carriage among hemodialysis patients and its influence on development of bloodstream MRSA infections.MethodologyThe present study was conducted as a prospective study between 1/10/2012 and 1/11/2013. 50 subjects who were on maintenance hemodialysis were observed for over 12months. All subjects gave informed consent for participation in the study, which was approved by the Human Ethics Committee. All of the procedures were in accordance with the Helsinki Declaration of 1975.Nasal specimens were collected using 2 sterile dry cotton-wool swabs for each patient. The swab was circled through both nostrils consecutively while applying an even pressure. Swabs were inoculated on to Mannitol Salt Agar and HiCrom agar (Hi MeReSe Media, HiMedia, Mumbai) simultaneously. Inoculated Mannitol Salt Agar (MSA) plates were incubated at 37°C for 24h. Yellow colonies were identified as S. aureus by standard conventional techniques.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> MRSA was detected by Oxacillin (1μg, HiMedia) by disk diffusion (DD) method, further confirmed by using Cefoxitin disk (1μg, HiMedia) which is an accurate surrogate marker for mecA gene detection. The diameter of zone of inhibition was recorded as per CLSI (Clinical and laboratory standards institute) guidelines.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> HiCrom agar was prepared as per the instruction manual. Inoculated plates were incubated at 37°C for 24h. Bright blue colonies on HiCrom agar were identified by standard techniques and MRSA confirmed by Oxacillin and Cefoxitin DISC. ATCC strain of S. aureus was used as the standard control strain.MRSA positive S. aureus carriage was defined by at least two positive cultures taken within a week. MRSA bloodstream infections are defined as the presence of MRSA bacteremia in bactec blood cultures in an HD patient in whom no other obvious source of infection was evident.Data were analyzed by using the SPSS software, version 13.0. The t-test and the chi-square test were used where appropriate. Continuous variables were presented as mean±standard deviation. p values less than 0.05 were considered as significant.ResultsA total of 50 ESRD patients on chronic hemodialysis were enrolled into this study. The age range of our study population was 28–74 years with mean age being 54.4±12.83 years. 74% of our patients were males and 26% were females. 70% of our patients were on thrice weekly hemodialysis, and 30% on two times dialysis per week. In our study population diabetic kidney disease was the leading cause for ESRD (80%), followed by hypertension (8%), chronic glomerulonephritis (6%), chronic tubulointerstitial nephritis (4%) and unknown causes (2%). Hemodialysis was performed through arteriovenous fistula (AVF) as vascular access in 76% of patients, tunneled cuffed hemodialysis catheters in 16% and arteriovenous graft (AVG) in 8% of patients (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>S. aureus nasal carrier state was detected in 31 of the 50 patients on hemodialysis (62%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Methicillin resistance rate was 83.87% (26 of 31) among the S. aureus nasal carriers. 33 episodes of bacteriologically proven MRSA bloodstream infections were detected in one-year period. 32 episodes of MRSA bloodstream infections are found in 26 MRSA positive nasal carriers as against only one episode of MRSA bloodstream infection in 5 non-MRSA nasal carriers (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). MRSA bloodstream infection rates were significantly higher among MRSA nasal carriers as compared to non-MRSA carriers (1.34 vs. 0.24 episode/100 patient-months, p<0.001).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Risk factors for the development of MRSA bloodstream infections were analyzed between MRSA positive and non-MRSA nasal carriers. There were no differences in age, gender, Diabetes, BMI, mode of dialysis, vascular access and duration of dialysis in either univariate or multivariate analysis (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Low hemoglobin levels were found in MRSA positive nasal carriers as compared to non-MRSA nasal carriers and these findings were statistically significant.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionNasal carriage of S. aureus plays a key role in the epidemiology and pathogenesis of staphylococcal infections. S. aureus nasal carriage has been shown to be more common in hemodialysis patients than in the general population.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> In our study the prevalence of S. aureus nasal carriage among hemodialysis patients was found to be 62%. This prevalence is consistent with the prevalence rates of 44.0–84.0% reported in other studies.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> Methicillin resistance in staphylococci has a low binding affinity for all β-lactam antibiotics. This MRSA is responsible for several difficult to treat infections in humans and their prevalence is progressively increasing. Nasal colonization of MRSA in patients on hemodialysis is reported to be 12–65%.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> In our study the prevalence of MRSA nasal carriage was found to be 52%. 83.87% of S. aureus nasal carriages were found to be MRSA.Hemodialysis patients with nasal carriage of S. aureus have a 1.8–4.7-fold increase of S. aureus bloodstream infections compared with non-carriers.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> The strains of S. aureus, which were recovered from the nostrils, are same as those recovered from subsequent bloodstream infections suggesting majority of S. aureus bloodstream infections are autoinfections.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Hemodialysis patients are particularly vulnerable to the development of MRSA carrier state and MRSA bloodstream infection. In our study, 33 episodes of MRSA bloodstream infections were detected in one-year period. Studies have shown that S. aureus nasal carriage act as an independent risk factor for the development of S. aureus bloodstream infections. In a study of 138 patients on peritoneal dialysis, almost 50% of patients with S. aureus bloodstream infections had nasal carriage of S. aureus.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> Lai and co-workers proposed that MRSA nasal carriage in patients receiving hemodialysis is associated with a 4.99-fold increased risk of infection-related mortality.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> In our study, the incidence of MRSA bloodstream infections were significantly high among MRSA nasal carriers (1.34 vs. 0.24 episodes per 100 patient-months, p<0.001).Prior histories of bacterial infection, history of diabetes, old age, the use of a dialysis catheter, lower hemoglobin level, lower serum albumin and iron overload are independent risk factors for bacterial infections in chronic hemodialysis patients.<a class="elsevierStyleCrossRefs" href="#bib0080">16–19</a> In our study, no statistically significant difference was observed in age, gender, diabetes, BMI, serum albumin levels, mode of dialysis, duration of dialysis, type of vascular access and urea reduction rate between MRSA and non-MRSA nasal carriers. Anemia was found be significantly more prevalent among MRSA carriers in our study. Our finding was consistent with those of Keane and Collins.<a class="elsevierStyleCrossRef" href="#bib0100">20</a>Our study has several limitations. Firstly, the number of study group was small. Secondly, the follow up period was short. Thirdly, characterization of the strains of MRSA in nasal carriers and bloodstream infections was not done in our study. Thus, we cannot establish the exact causal relationship between MRSA carriers and MRSA bloodstream infections.ConclusionThe present study demonstrates that MRSA nasal carriage was more prevalent in hemodialysis patients and it is an independent risk factor for the development of MRSA bloodstream infections. Prevention and treatment of MRSA nasal carriers with appropriate antibiotics may translate into reduction of MRSA bloodstream infections and infection-related mortality.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres395195" "titulo" => array:5 [ 0 => "Abstract" 1 => "Background" 2 => "Methodology" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec373008" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres395196" "titulo" => array:5 [ 0 => "Resumen" 1 => "Antecedentes" 2 => "Metodología" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec373007" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methodology" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-05-09" "fechaAceptado" => "2014-06-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec373008" "palabras" => array:5 [ 0 => "Hemodialysis" 1 => "Bloodstream infections" 2 => "Nasal carriage" 3 => "MRSA" 4 => "S. aureus" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec373007" "palabras" => array:5 [ 0 => "Hemodiálisis" 1 => "Infecciones hemáticas" 2 => "Portador nasal" 3 => "MRSA" 4 => "S. aureus" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "BackgroundMethicillin-resistance Staphylococcus aureus (MRSA) nasal carriage plays a key role in the pathogenesis of MRSA infections in hemodialysis patients. Our study was designed to evaluate the prevalence of MRSA nasal carriage in patients on chronic hemodialysis and its influence on development of MRSA bloodstream infections. MethodologyOurs is a 12-month prospective observational study. A total of 50 patients who are on chronic maintenance hemodialysis were enrolled in this study. Prevalence of MRSA nasal carriage was studied using nasal swabs collected from the anterior nares. Swabs were inoculated on to Mannitol Salt Agar and HiCrom agar. Bactec blood culture was used to detect MRSA bloodstream infections. ResultsStaphylococcus aureus (S. aureus) nasal carrier state was detected 62% of patients. 83.87% of these S. aureus nasal carriers were found to be having MRSA. The incidence of MRSA bloodstream infections was 1.54 episode per 100 patient-months. MRSA bloodstream infection rates were significantly higher among MRSA nasal carriers as compared to non-MRSA carriers (p<0.001). Low hemoglobin levels were significantly more among MRSA positive nasal carriers as compared to non-MRSA nasal carriers. ConclusionThis study reveals that MRSA nasal carriage is more prevalent among hemodialysis patients and it is an independent risk factor for the development of MRSA bloodstream infections. Early prevention and treatment of MRSA nasal carriage in hemodialysis patients may prevent MRSA bloodstream infections in hemodialysis patients." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "AntecedentesEl estado de portador nasal de Staphylococcus aureus resistente a meticilina (MRSA) desempeña un papel clave en la patogenia de las infecciones por MRSA en pacientes en hemodiálisis. Nuestro estudio se diseñó para evaluar la prevalencia de portadores nasales de MRSA en pacientes en hemodiálisis crónica y su influencia en la aparición de infecciones hemáticas por MRSA. MetodologíaSe realizó un estudio prospectivo observacional de 12 meses. Participaron en el estudio un total de 50 pacientes en hemodiálisis de mantenimiento crónica. Se estudió la prevalencia de portadores nasales de MRSA con el empleo de muestras con escobillón nasales obtenidas de la parte anterior de los orificios nasales. Los escobillones se inocularon en Manitol Salt Agar y agar HiCrom. Se utilizó un hemocultivo Bactec para detectar las infecciones hemáticas por MRSA. ResultadosSe detectó un estado de portador nasal de Staphylococcus aureus (S. aureus) en el 62% de los pacientes. En el 83,87% de estos portadores nasales de S. aureus se observó la presencia de MRSA. La incidencia de infecciones hemáticas por MRSA fue de 1,54 episodios por 100 meses-paciente. Las tasas de infección hemática por MRSA fueron significativamente superiores en los portadores nasales de MRSA en comparación con los no portadores de MRSA (p<0,001). Las concentraciones de hemoglobina bajas fueron significativamente más frecuentes en los portadores nasales positivos para MRSA en comparación con los no portadores nasales de MRSA. ConclusiónEste estudio pone de relieve que el estado de portador nasal de MRSA es más prevalente en los pacientes en hemodiálisis y constituye un factor de riesgo independiente para la aparición de infecciones hemáticas por MRSA. La prevención y tratamiento precoces del estado de portador nasal de MRSA en los pacientes en hemodiálisis pueden prevenir las infecciones hemáticas por MRSA en los pacientes en hemodiálisis." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1389 "Ancho" => 1553 "Tamanyo" => 82782 ] ] "descripcion" => array:1 [ "en" => "S. aureus nasal carriage among hemodialysis patients." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1326 "Ancho" => 1631 "Tamanyo" => 82823 ] ] "descripcion" => array:1 [ "en" => "MRSA bloodstream infections." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "AVF, arterio-venous fistula; AVG, arterio-venous graft; DM, diabetes mellitus; HTN, hypertension; CGN, chronic glomerulonephritis; CTIN, chronic tubulointerstitial nephritis." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n=50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.4±12.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Frequency of hemodialysis</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vascular access</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AVF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Catheter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AVG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Etiology for ESRD</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HTN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CGN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CTIN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab612927.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographics of hemodialysis patients." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "AVF, arterio-venous fistula; AVG, arterio-venous graft; BMI, body mass index; MRSA, methicillin resistant Staphylococcus aureus." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">MRSA +ve (n=26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">MRSA −ve (n=5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.9±13.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.0±10.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender, male:female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21:05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4:01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.6±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.4±3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duration of dialysis (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vascular access</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AVF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Catheter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AVG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serum creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.67±0.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.68±0.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemoglobin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.8±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.7±1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serum albumin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.4±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.6±0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urea reduction rate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.60±0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.61±0.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab612926.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of patients with and without MRSA nasal carriage." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of nasal carriage in 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Original article

Influencia del estado de portador nasal de Staphylococcus aureus resistente a meticilina (MRSA) en las infecciones hemáticas por MRSA en pacientes en hemodiálisis crónica

J.V. Sathisha, Pavan Malleshappab,

Corresponding author

dr_pavanm@yahoo.co.in

Corresponding author.

, M.K. Yashaswinia, Sulaiman Shariffa

a Department of Microbiology, Adichunchanagiri Institute of Medical Sciences, B. G. Nagara, Karnataka, India

b Division of Nephrology, Department of Medicine, Adichunchanagiri Institute of Medical Sciences, B. G. Nagara, Karnataka, India

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Self-inoculation occurs when organisms from the nose colonize other areas of the skin leading to infection&#46; Studies have found that nasal colonization with methicillin-resistant <span class="elsevierStyleItalic">S&#46;</span> aureus &#40;MRSA&#41; poses an increased risk of infection&#46; MRSA strains are resistant to several groups of broad-spectrum antibiotics&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This mechanism of increased spreading under antibiotic pressure may contribute to the worldwide increase in the prevalence of MRSA in hospitals&#46; Hemodialysis patients are particularly vulnerable to staphylococcal colonization as well as infections&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Little is known about the prevalence of MRSA among hemodialysis patients in India&#46; The purpose of this study was to determine the prevalence of MRSA nasal carriage among hemodialysis patients and its influence on development of bloodstream MRSA infections&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0010" class="elsevierStylePara elsevierViewall">The present study was conducted as a prospective study between 1&#47;10&#47;2012 and 1&#47;11&#47;2013&#46; 50 subjects who were on maintenance hemodialysis were observed for over 12<span class="elsevierStyleHsp" style=""></span>months&#46; All subjects gave informed consent for participation in the study&#44; which was approved by the Human Ethics Committee&#46; All of the procedures were in accordance with the Helsinki Declaration of 1975&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Nasal specimens were collected using 2 sterile dry cotton-wool swabs for each patient&#46; The swab was circled through both nostrils consecutively while applying an even pressure&#46; Swabs were inoculated on to Mannitol Salt Agar and HiCrom agar &#40;Hi MeReSe Media&#44; HiMedia&#44; Mumbai&#41; simultaneously&#46; Inoculated Mannitol Salt Agar &#40;MSA&#41; plates were incubated at 37<span class="elsevierStyleHsp" style=""></span>&#176;C for 24<span class="elsevierStyleHsp" style=""></span>h&#46; Yellow colonies were identified as <span class="elsevierStyleItalic">S&#46; aureus</span> by standard conventional techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> MRSA was detected by Oxacillin &#40;1<span class="elsevierStyleHsp" style=""></span>&#956;g&#44; HiMedia&#41; by disk diffusion &#40;DD&#41; method&#44; further confirmed by using Cefoxitin disk &#40;1<span class="elsevierStyleHsp" style=""></span>&#956;g&#44; HiMedia&#41; which is an accurate surrogate marker for mecA gene detection&#46; The diameter of zone of inhibition was recorded as per CLSI &#40;Clinical and laboratory standards institute&#41; guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> HiCrom agar was prepared as per the instruction manual&#46; Inoculated plates were incubated at 37<span class="elsevierStyleHsp" style=""></span>&#176;C for 24<span class="elsevierStyleHsp" style=""></span>h&#46; Bright blue colonies on HiCrom agar were identified by standard techniques and MRSA confirmed by Oxacillin and Cefoxitin DISC&#46; ATCC strain of <span class="elsevierStyleItalic">S&#46; aureus</span> was used as the standard control strain&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">MRSA positive <span class="elsevierStyleItalic">S&#46; aureus</span> carriage was defined by at least two positive cultures taken within a week&#46; MRSA bloodstream infections are defined as the presence of MRSA bacteremia in bactec blood cultures in an HD patient in whom no other obvious source of infection was evident&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Data were analyzed by using the SPSS software&#44; version 13&#46;0&#46; The <span class="elsevierStyleItalic">t</span>-test and the chi-square test were used where appropriate&#46; Continuous variables were presented as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46; <span class="elsevierStyleItalic">p</span> values less than 0&#46;05 were considered as significant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 50 ESRD patients on chronic hemodialysis were enrolled into this study&#46; The age range of our study population was 28&#8211;74 years with mean age being 54&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;83 years&#46; 74&#37; of our patients were males and 26&#37; were females&#46; 70&#37; of our patients were on thrice weekly hemodialysis&#44; and 30&#37; on two times dialysis per week&#46; In our study population diabetic kidney disease was the leading cause for ESRD &#40;80&#37;&#41;&#44; followed by hypertension &#40;8&#37;&#41;&#44; chronic glomerulonephritis &#40;6&#37;&#41;&#44; chronic tubulointerstitial nephritis &#40;4&#37;&#41; and unknown causes &#40;2&#37;&#41;&#46; Hemodialysis was performed through arteriovenous fistula &#40;AVF&#41; as vascular access in 76&#37; of patients&#44; tunneled cuffed hemodialysis catheters in 16&#37; and arteriovenous graft &#40;AVG&#41; in 8&#37; of patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">S&#46; aureus</span> nasal carrier state was detected in 31 of the 50 patients on hemodialysis &#40;62&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Methicillin resistance rate was 83&#46;87&#37; &#40;26 of 31&#41; among the <span class="elsevierStyleItalic">S&#46; aureus</span> nasal carriers&#46; 33 episodes of bacteriologically proven MRSA bloodstream infections were detected in one-year period&#46; 32 episodes of MRSA bloodstream infections are found in 26 MRSA positive nasal carriers as against only one episode of MRSA bloodstream infection in 5 non-MRSA nasal carriers &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; MRSA bloodstream infection rates were significantly higher among MRSA nasal carriers as compared to non-MRSA carriers &#40;1&#46;34 vs&#46; 0&#46;24 episode&#47;100 patient-months&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Risk factors for the development of MRSA bloodstream infections were analyzed between MRSA positive and non-MRSA nasal carriers&#46; There were no differences in age&#44; gender&#44; Diabetes&#44; BMI&#44; mode of dialysis&#44; vascular access and duration of dialysis in either univariate or multivariate analysis &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Low hemoglobin levels were found in MRSA positive nasal carriers as compared to non-MRSA nasal carriers and these findings were statistically significant&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Nasal carriage of <span class="elsevierStyleItalic">S&#46; aureus</span> plays a key role in the epidemiology and pathogenesis of staphylococcal infections&#46; <span class="elsevierStyleItalic">S&#46; aureus</span> nasal carriage has been shown to be more common in hemodialysis patients than in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In our study the prevalence of <span class="elsevierStyleItalic">S&#46; aureus</span> nasal carriage among hemodialysis patients was found to be 62&#37;&#46; This prevalence is consistent with the prevalence rates of 44&#46;0&#8211;84&#46;0&#37; reported in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> Methicillin resistance in staphylococci has a low binding affinity for all &#946;-lactam antibiotics&#46; This MRSA is responsible for several difficult to treat infections in humans and their prevalence is progressively increasing&#46; Nasal colonization of MRSA in patients on hemodialysis is reported to be 12&#8211;65&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> In our study the prevalence of MRSA nasal carriage was found to be 52&#37;&#46; 83&#46;87&#37; of <span class="elsevierStyleItalic">S&#46; aureus</span> nasal carriages were found to be MRSA&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Hemodialysis patients with nasal carriage of <span class="elsevierStyleItalic">S&#46; aureus</span> have a 1&#46;8&#8211;4&#46;7-fold increase of <span class="elsevierStyleItalic">S&#46; aureus</span> bloodstream infections compared with non-carriers&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The strains of <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; which were recovered from the nostrils&#44; are same as those recovered from subsequent bloodstream infections suggesting majority of <span class="elsevierStyleItalic">S&#46; aureus</span> bloodstream infections are autoinfections&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Hemodialysis patients are particularly vulnerable to the development of MRSA carrier state and MRSA bloodstream infection&#46; In our study&#44; 33 episodes of MRSA bloodstream infections were detected in one-year period&#46; Studies have shown that <span class="elsevierStyleItalic">S&#46; aureus</span> nasal carriage act as an independent risk factor for the development of <span class="elsevierStyleItalic">S&#46; aureus</span> bloodstream infections&#46; In a study of 138 patients on peritoneal dialysis&#44; almost 50&#37; of patients with <span class="elsevierStyleItalic">S&#46; aureus</span> bloodstream infections had nasal carriage of <span class="elsevierStyleItalic">S&#46; aureus</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Lai and co-workers proposed that MRSA nasal carriage in patients receiving hemodialysis is associated with a 4&#46;99-fold increased risk of infection-related mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> In our study&#44; the incidence of MRSA bloodstream infections were significantly high among MRSA nasal carriers &#40;1&#46;34 vs&#46; 0&#46;24 episodes per 100 patient-months&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Prior histories of bacterial infection&#44; history of diabetes&#44; old age&#44; the use of a dialysis catheter&#44; lower hemoglobin level&#44; lower serum albumin and iron overload are independent risk factors for bacterial infections in chronic hemodialysis patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;19</span></a> In our study&#44; no statistically significant difference was observed in age&#44; gender&#44; diabetes&#44; BMI&#44; serum albumin levels&#44; mode of dialysis&#44; duration of dialysis&#44; type of vascular access and urea reduction rate between MRSA and non-MRSA nasal carriers&#46; Anemia was found be significantly more prevalent among MRSA carriers in our study&#46; Our finding was consistent with those of Keane and Collins&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Our study has several limitations&#46; Firstly&#44; the number of study group was small&#46; Secondly&#44; the follow up period was short&#46; Thirdly&#44; characterization of the strains of MRSA in nasal carriers and bloodstream infections was not done in our study&#46; Thus&#44; we cannot establish the exact causal relationship between MRSA carriers and MRSA bloodstream infections&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">The present study demonstrates that MRSA nasal carriage was more prevalent in hemodialysis patients and it is an independent risk factor for the development of MRSA bloodstream infections&#46; Prevention and treatment of MRSA nasal carriers with appropriate antibiotics may translate into reduction of MRSA bloodstream infections and infection-related mortality&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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          "titulo" => "Keywords"
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          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Antecedentes"
            2 => "Metodolog&#237;a"
            3 => "Resultados"
            4 => "Conclusi&#243;n"
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          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methodology"
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          "identificador" => "sec0030"
          "titulo" => "Conflict of interest"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2014-05-09"
    "fechaAceptado" => "2014-06-18"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec373008"
          "palabras" => array:5 [
            0 => "Hemodialysis"
            1 => "Bloodstream infections"
            2 => "Nasal carriage"
            3 => "MRSA"
            4 => "<span class="elsevierStyleItalic">S&#46; aureus</span>"
          ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec373007"
          "palabras" => array:5 [
            0 => "Hemodi&#225;lisis"
            1 => "Infecciones hem&#225;ticas"
            2 => "Portador nasal"
            3 => "MRSA"
            4 => "<span class="elsevierStyleItalic">S&#46; aureus</span>"
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Methicillin-resistance <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;MRSA&#41; nasal carriage plays a key role in the pathogenesis of MRSA infections in hemodialysis patients&#46; Our study was designed to evaluate the prevalence of MRSA nasal carriage in patients on chronic hemodialysis and its influence on development of MRSA bloodstream infections&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methodology</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ours is a 12-month prospective observational study&#46; A total of 50 patients who are on chronic maintenance hemodialysis were enrolled in this study&#46; Prevalence of MRSA nasal carriage was studied using nasal swabs collected from the anterior nares&#46; Swabs were inoculated on to Mannitol Salt Agar and HiCrom agar&#46; Bactec blood culture was used to detect MRSA bloodstream infections&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;<span class="elsevierStyleItalic">S&#46; aureus</span>&#41; nasal carrier state was detected 62&#37; of patients&#46; 83&#46;87&#37; of these <span class="elsevierStyleItalic">S&#46; aureus</span> nasal carriers were found to be having MRSA&#46; The incidence of MRSA bloodstream infections was 1&#46;54 episode per 100 patient-months&#46; MRSA bloodstream infection rates were significantly higher among MRSA nasal carriers as compared to non-MRSA carriers &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Low hemoglobin levels were significantly more among MRSA positive nasal carriers as compared to non-MRSA nasal carriers&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This study reveals that MRSA nasal carriage is more prevalent among hemodialysis patients and it is an independent risk factor for the development of MRSA bloodstream infections&#46; Early prevention and treatment of MRSA nasal carriage in hemodialysis patients may prevent MRSA bloodstream infections in hemodialysis patients&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El estado de portador nasal de <span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a meticilina &#40;MRSA&#41; desempe&#241;a un papel clave en la patogenia de las infecciones por MRSA en pacientes en hemodi&#225;lisis&#46; Nuestro estudio se dise&#241;&#243; para evaluar la prevalencia de portadores nasales de MRSA en pacientes en hemodi&#225;lisis cr&#243;nica y su influencia en la aparici&#243;n de infecciones hem&#225;ticas por MRSA&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Metodolog&#237;a</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio prospectivo observacional de 12 meses&#46; Participaron en el estudio un total de 50 pacientes en hemodi&#225;lisis de mantenimiento cr&#243;nica&#46; Se estudi&#243; la prevalencia de portadores nasales de MRSA con el empleo de muestras con escobill&#243;n nasales obtenidas de la parte anterior de los orificios nasales&#46; Los escobillones se inocularon en Manitol Salt Agar y agar HiCrom&#46; Se utiliz&#243; un hemocultivo Bactec para detectar las infecciones hem&#225;ticas por MRSA&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se detect&#243; un estado de portador nasal de <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;<span class="elsevierStyleItalic">S&#46; aureus</span>&#41; en el 62&#37; de los pacientes&#46; En el 83&#44;87&#37; de estos portadores nasales de <span class="elsevierStyleItalic">S&#46; aureus</span> se observ&#243; la presencia de MRSA&#46; La incidencia de infecciones hem&#225;ticas por MRSA fue de 1&#44;54 episodios por 100 meses-paciente&#46; Las tasas de infecci&#243;n hem&#225;tica por MRSA fueron significativamente superiores en los portadores nasales de MRSA en comparaci&#243;n con los no portadores de MRSA &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Las concentraciones de hemoglobina bajas fueron significativamente m&#225;s frecuentes en los portadores nasales positivos para MRSA en comparaci&#243;n con los no portadores nasales de MRSA&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este estudio pone de relieve que el estado de portador nasal de MRSA es m&#225;s prevalente en los pacientes en hemodi&#225;lisis y constituye un factor de riesgo independiente para la aparici&#243;n de infecciones hem&#225;ticas por MRSA&#46; La prevenci&#243;n y tratamiento precoces del estado de portador nasal de MRSA en los pacientes en hemodi&#225;lisis pueden prevenir las infecciones hem&#225;ticas por MRSA en los pacientes en hemodi&#225;lisis&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AVF&#44; arterio-venous fistula&#59; AVG&#44; arterio-venous graft&#59; DM&#44; diabetes mellitus&#59; HTN&#44; hypertension&#59; CGN&#44; chronic glomerulonephritis&#59; CTIN&#44; chronic tubulointerstitial nephritis&#46;</p>"
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                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 18862845
Original language: English

DOI:10.1016/j.dialis.2014.06.007

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Year/Month	Html	Pdf	Total

2024 November	3	4	7
2024 October	36	6	42
2024 September	47	4	51
2024 August	48	7	55
2024 July	56	8	64
2024 June	43	3	46
2024 May	32	8	40
2024 April	40	12	52
2024 March	39	11	50
2024 February	35	8	43
2024 January	50	7	57
2023 December	46	16	62
2023 November	37	18	55
2023 October	33	16	49
2023 September	29	9	38
2023 August	25	6	31
2023 July	57	12	69
2023 June	46	7	53
2023 May	42	15	57
2023 April	28	5	33
2023 March	19	6	25
2023 February	27	6	33
2023 January	21	16	37
2022 December	25	10	35
2022 November	21	13	34
2022 October	21	16	37
2022 September	26	21	47
2022 August	30	15	45
2022 July	28	7	35
2022 June	19	5	24
2022 May	29	15	44
2022 April	72	14	86
2022 March	95	9	104
2022 February	110	9	119
2022 January	78	8	86
2021 December	40	24	64
2021 November	50	11	61
2021 October	38	20	58
2021 September	35	22	57
2021 August	34	17	51
2021 July	33	17	50
2021 June	25	10	35
2021 May	55	16	71
2021 April	96	26	122
2021 March	46	16	62
2021 February	42	10	52
2021 January	44	20	64
2020 December	60	14	74
2020 November	36	9	45
2020 October	26	8	34
2020 September	20	20	40
2020 August	41	20	61
2020 July	29	13	42
2020 June	37	13	50
2020 May	54	33	87
2020 April	36	8	44
2020 March	44	17	61
2020 February	24	22	46
2020 January	49	28	77
2019 December	38	23	61
2019 November	34	31	65
2019 October	35	25	60
2019 September	26	14	40
2019 August	31	11	42
2019 July	34	30	64
2019 June	55	54	109
2019 May	125	56	181
2019 April	72	53	125
2019 March	17	11	28
2019 February	15	12	27
2019 January	17	10	27
2018 December	14	16	30
2018 November	27	18	45
2018 October	16	26	42
2018 September	22	5	27
2018 August	4	3	7
2018 July	10	4	14
2018 June	15	3	18
2018 May	9	2	11
2018 April	12	1	13
2018 March	7	2	9
2018 February	16	1	17
2018 January	12	1	13
2017 December	10	0	10
2017 November	9	1	10
2017 October	12	1	13
2017 September	10	1	11
2017 August	14	5	19
2017 July	12	2	14
2017 June	25	4	29
2017 May	18	2	20
2017 April	23	1	24
2017 March	20	29	49
2017 February	21	0	21
2017 January	23	4	27
2016 December	19	3	22
2016 November	30	3	33
2016 October	40	11	51
2016 September	2	0	2
2015 November	0	2	2
2015 January	1	1	2

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