Giuseppe
Emeritus
[Source: Clinical Infectious Diseases Journal, full page: (LINK). Abstract, edited.]
Invasive Methicillin-Resistant Staphylococcus aureus Infections Among Chronic Dialysis Patients in the United States, 2005?2011
Duc B. Nguyen 1,2, Fernanda C. Lessa 1, Ruth Belflower 1,3, Yi Mu 1, Matthew Wise 1, Joelle Nadle 4, Wendy M. Bamberg 5, Susan Petit 6, Susan M. Ray 7, Lee H. Harrison 8, Ruth Lynfield 9, Ghinwa Dumyati 10, Jamie Thompson 11, William Schaffner 12, Priti R. Patel 1, for the Active Bacterial Core surveillance (ABCs) MRSA Investigators of the Emerging Infections Program
Author Affiliations: <SUP>1</SUP>Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA <SUP>2</SUP>Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA <SUP>3</SUP>Atlanta Research and Education Foundation, Atlanta, Georgia, USA <SUP>4</SUP>California Emerging Infections Program, Oakland, California, USA <SUP>5</SUP>Colorado Department of Public Health and Environment, Denver, Colorado, USA <SUP>6</SUP>Connecticut Department of Public Health, Hartford, Connecticut, USA <SUP>7</SUP>Emory University School of Medicine and Georgia Emerging Infections Program, Atlanta, Georgia, USA <SUP>8</SUP>Maryland Emerging Infections Program and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA <SUP>9</SUP>Minnesota Department of Health, St. Paul, Minnesota, USA <SUP>10</SUP>University of Rochester, Rochester, New York, USA <SUP>11</SUP>Oregon Public Health Division, Portland, Oregon, USA <SUP>12</SUP>Vanderbilt University School of Medicine, Nashville, Tennessee, USA
Correspondence: Duc B. Nguyen, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A35, Atlanta, GA 30333. Email: (vif8@cdc.gov). , Phone: (404) 639-0027, Fax: (404) 639-4046
Abstract
Background.
Approximately 15,700 invasive methicillin-resistant Staphylococcus aureus (MRSA) infections occurred in U.S. dialysis patients in 2010. Frequent hospital visits and prolonged bloodstream access, especially via central venous catheters (CVCs), are risk factors among hemodialysis patients. We describe the epidemiology of and recent trends in invasive MRSA infections among dialysis patients.
Methods.
We analyzed population-based data from nine U.S. metropolitan areas from 2005?2011.
Cases were defined as MRSA isolated from a normally sterile body site in a surveillance area resident who received dialysis, and were classified as hospital-onset (HO) (culture collected >3 days after hospital admission) or healthcare-associated community-onset (HACO) (all others).
Incidence was calculated using denominators from the U.S. Renal Data System. Temporal trends in incidence and national estimates were calculated controlling for age, gender, and race.
Results.
From 2005?2011, 7,489 cases were identified; 85.7% were HACO; 93.2% were bloodstream infections. Incidence of invasive MRSA infections decreased from 6.5 to 4.2 per 100 dialysis patients (annual decrease: 7.3%) with annual decreases of 6.7% for HACO and 10.5% for HO cases. Of cases identified during 2009-2011, 70% were hospitalized in the year prior to infection. Among hemodialysis cases, 60.4% were dialyzed through a CVC. The 2011 national estimated number of MRSA infections was 15,169.
Conclusions.
There has been a substantial decrease in invasive MRSA infection incidence among dialysis patients. Most cases had previous hospitalizations, suggesting that efforts to control MRSA in hospitals might have contributed to the declines. Infection prevention measures should include improved vascular access and CVC care.
Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013.
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Invasive Methicillin-Resistant Staphylococcus aureus Infections Among Chronic Dialysis Patients in the United States, 2005?2011
Duc B. Nguyen 1,2, Fernanda C. Lessa 1, Ruth Belflower 1,3, Yi Mu 1, Matthew Wise 1, Joelle Nadle 4, Wendy M. Bamberg 5, Susan Petit 6, Susan M. Ray 7, Lee H. Harrison 8, Ruth Lynfield 9, Ghinwa Dumyati 10, Jamie Thompson 11, William Schaffner 12, Priti R. Patel 1, for the Active Bacterial Core surveillance (ABCs) MRSA Investigators of the Emerging Infections Program
Author Affiliations: <SUP>1</SUP>Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA <SUP>2</SUP>Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA <SUP>3</SUP>Atlanta Research and Education Foundation, Atlanta, Georgia, USA <SUP>4</SUP>California Emerging Infections Program, Oakland, California, USA <SUP>5</SUP>Colorado Department of Public Health and Environment, Denver, Colorado, USA <SUP>6</SUP>Connecticut Department of Public Health, Hartford, Connecticut, USA <SUP>7</SUP>Emory University School of Medicine and Georgia Emerging Infections Program, Atlanta, Georgia, USA <SUP>8</SUP>Maryland Emerging Infections Program and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA <SUP>9</SUP>Minnesota Department of Health, St. Paul, Minnesota, USA <SUP>10</SUP>University of Rochester, Rochester, New York, USA <SUP>11</SUP>Oregon Public Health Division, Portland, Oregon, USA <SUP>12</SUP>Vanderbilt University School of Medicine, Nashville, Tennessee, USA
Correspondence: Duc B. Nguyen, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A35, Atlanta, GA 30333. Email: (vif8@cdc.gov). , Phone: (404) 639-0027, Fax: (404) 639-4046
Abstract
Background.
Approximately 15,700 invasive methicillin-resistant Staphylococcus aureus (MRSA) infections occurred in U.S. dialysis patients in 2010. Frequent hospital visits and prolonged bloodstream access, especially via central venous catheters (CVCs), are risk factors among hemodialysis patients. We describe the epidemiology of and recent trends in invasive MRSA infections among dialysis patients.
Methods.
We analyzed population-based data from nine U.S. metropolitan areas from 2005?2011.
Cases were defined as MRSA isolated from a normally sterile body site in a surveillance area resident who received dialysis, and were classified as hospital-onset (HO) (culture collected >3 days after hospital admission) or healthcare-associated community-onset (HACO) (all others).
Incidence was calculated using denominators from the U.S. Renal Data System. Temporal trends in incidence and national estimates were calculated controlling for age, gender, and race.
Results.
From 2005?2011, 7,489 cases were identified; 85.7% were HACO; 93.2% were bloodstream infections. Incidence of invasive MRSA infections decreased from 6.5 to 4.2 per 100 dialysis patients (annual decrease: 7.3%) with annual decreases of 6.7% for HACO and 10.5% for HO cases. Of cases identified during 2009-2011, 70% were hospitalized in the year prior to infection. Among hemodialysis cases, 60.4% were dialyzed through a CVC. The 2011 national estimated number of MRSA infections was 15,169.
Conclusions.
There has been a substantial decrease in invasive MRSA infection incidence among dialysis patients. Most cases had previous hospitalizations, suggesting that efforts to control MRSA in hospitals might have contributed to the declines. Infection prevention measures should include improved vascular access and CVC care.
Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013.
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