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MRSA rampant among patients on dialysis
Emerging vancomycin resistance also linked
The rate of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection in dialysis patients is higher than for any other known patient population, and is 100 times higher than for the general population, the Centers for Disease Control and Prevention reports.1
In 2005, the incidence of invasive MRSA infection among dialysis patients was 45.2 cases per 1,000 population. People receiving dialysis are at high risk for infection with invasive MRSA compared with the general population, in which rates of invasive MRSA have ranged from 0.2 to 0.4 infections per 1,000 population. The findings "underscore the need for continued surveillance and infection-control strategies aimed at reducing infection rates and preventing additional antimicrobial resistance among persons receiving dialysis," the CDC emphasized.
The CDC report refers ICPs to 2001 infection control guidelines for dialysis, which emphasize that standard precautions — as opposed to more rigorous contact isolation measures — are generally adequate for dialysis settings. However, the emerging data on MRSA raise the question of whether lack of compliance with infection control measures is a part of the problem. In a nutshell, could dialysis settings be amplifying the problem?
"We know that adherence to infection control guidelines is a challenge in many settings," says Cynthia A. Lucero, MD, an epidemic intelligence service officer in the CDC's division of healthcare quality promotion. "This [dialysis] study did not attempt to assess adherence to infection control guidelines by physicians or dialysis center personnel or the effect of treatment in a dialysis center setting on the risk of infection. I am not aware of any U.S. study that has specifically done that.
Hopefully, this report will serve to inform or remind individuals providing care to dialysis patients that recommendations for preventing transmission of infections and antimicrobial resistance among dialysis patients have been published by the CDC, and are available for reference. Care providers may wish to review these recommendations to make sure that risks of infection are minimized where possible."
1. Centers for Disease Control and Prevention (CDC). Invasive methicillin-resistant Staphylococcus aureus infections among dialysis patients — United States, 2005. MMWR. Morb Mortal Wkly Rep. 2007;56:197-199.