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

Korean J Nosocomial Infect Control. 2013 Dec;18(2):51-56. Korean.
Published online December 26, 2013.  https://doi.org/10.14192/kjnic.2013.18.2.51
Copyright © 2013 Korean Society for Nosocomial Infection Control
Nasal Colonization and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus among Hemodialysis Patients in 7 Korean Hospitals
Jae-Seok Kim,1 Sun-Hwa Lee,2 Joseph Jeong,3 Kyoung Ho Roh,4 Hae-Kyung Lee,5 Sook Jin Jang,6 Hye Soo Lee,7 Jeong-Uk Kim,8 Sung Hee Lee,9 Joon Sup Yeom,10 Sang Oh Lee,11 Jeong Sil Choi,12 So-Yeon Yoo,13 Jae Sim Jeong,14 and Mi-Na Kim15
1Department of Laboratory Medicine, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea.
2Neodin Medical Institute, Seoul, Korea.
3Department of Laboratory Medicine, University of Ulsan and Ulsan University Hospital, Ulsan, Korea.
4Department of Laboratory Medicine, Korea University College of Medicine, Anam Hospital, Seoul, Korea.
5Department of Laboratory Medicine, The Catholic University of Korea College of Medicine, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea.
6Department of Laboratory Medicine, Chosun University College of Medicine, Gwangju, Korea.
7Department of Laboratory Medicine, Chonbuk National University Medical School, Jeonju, Korea.
8Department of Laboratory Medicine, University of Ulsan College of Medicine and Gangnung Asan Hospital, Gangnung, Korea.
9Department of Laboratory Medicine, Hanmaeum General Hospital, Jeju, Korea.
10Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea.
11Department of Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
12Nursing College, Gachon University, Incheon, Korea.
13Infection Control Office, The Catholic University of Korea College of Medicine, St. Vincent's Hospital, Suwon, Korea.
14Department of Clinical Nursing, University of Ulsan College of Medicine, Ulsan, Korea.
15Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.

Correspondence to: Mi-Na Kim, Department of Laboratory Medicine, University of Ulsan and Asan Medical Center, 88, Olympic-ro 43 gil, Songpa-gu, Seoul 138-736, Korea. Tel: 02-3010-4511, Fax: 02-478-0884, Email: mnkim@amc.seoul.kr
Received August 21, 2013; Revised October 10, 2013; Accepted October 18, 2013.

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.

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

Tables


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
Click for larger image

Notes

This study was granted by Korean Centers for Disease Control and Prevention in 2009.

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