Journal List > Korean J Nosocomial Infect Control > v.18(2) > 1098337

Kim, Lee, Jeong, Roh, Lee, Jang, Lee, Kim, Lee, Yeom, Lee, Choi, Yoo, Jeong, and Kim: Nasal Colonization and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus among Hemodialysis Patients in 7 Korean Hospitals

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.

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Table 1.
Characteristics of methicillin-resistant Staphylococcus aureus isolates from nasal swabs of dialysis patients and nurses according to the hospitals and particular SCCmec subtypes
Hospital No. No. of patients No. (%) of MRSA carriage in patients No. (%) of SCCmec subtypes
No. of nurses No. (%) of MRSA carriage in nurses No. (%) of SCCmec subtypes
II IIa IIb III IV IVa IIb IV IVa
1 45 3 (6.7)     3       11 0      
2 78 6 (7.7)   1 3   2   N/A N/A      
3 84 8 (9.5) 1         7 13 2 (15.4) 1   1
4 50 5 (10.0) 1   2   1 1 10 2 (20.0) 1 1  
5 54 6 (11.1)     3     3 13 0      
6 87 13 (14.9)     7 1 2 3 11 0      
7 84 16 (19.0) 1   12   1 2 9 1 (11.1)     1
Total 482 57 3 1 30 1 6 16 67 5 2 1 2
    (11.8) (5.3) (1.8) (52.6) (1.8) (10.5) (28.1)   (7.5) (40.0) (20.0) (40.0)

One of SCCmec IV MRSA isolate possessed Panton-Valentine leukocidin gene.

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