Prevalence of Colonization With Community-Associated Methicillin-ResistantStaphylococcus aureusAmong End-Stage Renal Disease Patients and Healthcare Workers

Abstract

Objective.To evaluate the prevalence, epidemiologic features, and molecular characteristics of colonization with community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) among hospitalized dialysis patients and their healthcare workers (HCWs).Design.Prospective observational clinical and laboratory study of nasal colonization.Setting.A 600-bed urban academic medical center.Subjects.One hundred twenty hospitalized dialysis inpatients and 100 HCWs.Results.Of 120 patients, 40 (33%) were colonized withS. aureus; 26 (65%) of these 40 were colonized with MRSA. Among the 26 MRSA isolates, 10 (38.5%) carried staphylococcal cassette chromosome (SCC)mectype IV (ie, CA-MRSA), and 7 of these 10 carried the genes for the Panton-Valentine leukocidin (PVL) toxin. Patients colonized with healthcare-associated MRSA strains and those colonized with CA-MRSA strains were similar, except for a higher frequency of a history of congestive heart failure among those with healthcare-associated MRSA strains (P= .014). Among 10 patients who presented with or developed anS. aureusinfection while hospitalized, 8 were colonized withS. aureus, 7 with MRSA, and 3 with SCCmectype IV strains. Among 100 HCWs, 31 were colonized withS. aureus, including 6 with MRSA; 2 of the MRSA isolates belonged to CA-MRSA strains, and soft-tissue infections were reported in one of the HCWs and in the family member of the other HCW colonized with these strains.Conclusions.There is a high rate of colonization with MRSA and CA-MRSA among hospitalized dialysis patients and their HCWs. As other studies have found, it appears that individuals are being colonized with both CA-MRSA strains and healthcare-associated MRSA strains.