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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
Original Article

Korean J Nosocomial Infect Control 2013;18(2):51-56.

Published online: 5 January 2013

DOI: https://doi.org/10.14192/kjnic.2013.18.2.51

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

Jae-Seok Kim1, Sun-Hwa Lee2, Joseph Jeong3, Kyoung Ho Roh4, Hae-Kyung Lee5, Sook Jin Jang6, Hye Soo Lee7, Jeong-Uk Kim8, Sung Hee Lee9, Joon Sup Yeom10, Sang Oh Lee11, Jeong Sil Choi12, So-Yeon Yoo13, Jae Sim Jeong14, Mi-Na Kim15

Department of Laboratory Medicine, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea

Neodin Medical Institute, Seoul, Korea

Department of Laboratory Medicine, University of Ulsan and Ulsan University Hospital, Seoul, Korea

Ulsan, Korea University College of Medicine, Anam Hospital, Seoul, Korea

Seoul, The Catholic University of Korea College of Medicine, Uijeongbu St. Mary's Hospital, Seoul, Korea

Uijeongbu, Chosun University College of Medicine, Seoul, Korea

Gwangju, Chonbuk National University Medical School, Seoul, Korea

Jeonju, University of Ulsan College of Medicine and Gangnung Asan Hospital, Seoul, Korea

Gangnung, Hanmaeum General Hospital, Seoul, Korea

Jeju, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea

University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

Seoul, Nursing College, Gachon University, Incheon, Seoul, Korea

Infection Control Office, The Catholic University of Korea College of Medicine, St. Vincent's Hospital, Seoul, Korea

Suwon, Department of Clinical Nursing, University of Ulsan College of Medicine, Seoul, Korea

Ulsan, Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

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

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: 02478-0884 E-mail: mnkim@amc.seoul.kr

Received 21 August 2013       Accepted 18 October 2013

Copyright © 2013 Korean Society for Nosocomial Infection Control

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

References

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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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