Staphylococcus aureus colonization increases the risk of bacteremia in hemodialysis patients: a molecular epidemiology approach with time-dependent analysis - 19/01/21
Highlights |
• | Bacterial colonization has been suggested as a risk factor for bacteremia. |
• | Staphylococcus aureus colonization was associated with the time-to-first-bacteremia. |
• | S aureus colonization was also associated with the recurrence of infection. |
• | Multidrug-resistant Gram-negative bacilli colonization was not associated with bacteremia. |
• | Prompt identification of colonized patients and evaluation of decolonization protocols are needed. |
Résumé |
Background |
Bacteremia is the second cause of death in hemodialysis patients and colonization may be a risk factor. We analyzed the association between Staphylococcus aureus or multidrug-resistant Gram-negative bacteria colonization and bacteremia in hemodialysis patients.
Methods |
A prospective cohort study was conducted. Colonization status was determined at baseline, 2, and 6 months later. The time-to-first-bacteremia was analyzed using the baseline status and time-dependent nature of colonization. The recurrence of bacteremia given colonization status was evaluated using a Poisson regression model. The genetic relatedness between isolates that colonized and caused bacteremia were established by molecular typing methods.
Results |
Seventy-one patients developed bacteremia over the course of follow-up, with the majority of cases being caused by S aureus (n = 28; 39.4%) and only three caused by multidrug-resistant Gram-negative bacteria. S aureus colonization was associated with an increased risk of bacteremia in time-dependent analysis (HR:4.64; 95%CI: 1.72-12.53) and with recurrence of infection in Poisson model (IRR:5.90, 95%CI: 2.29-15.16). Molecular methods revealed that 77.8% of patients with S aureus bacteremia were colonized with the same strain that caused the infection.
Conclusions |
S aureus is a cause of endogenous infection in hemodialysis patients. Colonization is associated with both time-to-first-bacteremia and the recurrence of infection. The prompt identification of colonized patients and the evaluation of decolonization protocols are needed.
Le texte complet de cet article est disponible en PDF.Key Words : Nephrology, Infection, Bacteria, Epidemiology, Molecular biology, Survival analysis
Plan
| Funding: This work was supported by Comité para el Desarrollo de la Investigación CODI, Universidad de Antioquia, project: 2017-15526 and Departamento Administrativo de Ciencia, Tecnología e innovación Colciencias, project: 111577756947. Funding sources had no involvement in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication. |
|
| Conflict of Interest: All authors report no conflicts of interest to this article. |
Vol 49 - N° 2
P. 215-223 - février 2021 Retour au numéro
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