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Korean J healthc assoc Infect Control Prev 2013; 18(2): 51-56

Published online December 30, 2013 https://doi.org/10.14192/kjnic.2013.18.2.51

Copyright © Korean Society for Healthcare-associated infection Control and Prevention

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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 Hospital1, Neodin Medical Institute2, Department of Laboratory Medicine, University of Ulsan and Ulsan University Hospital3, Ulsan, Korea University College of Medicine, Anam Hospital4, Seoul, The Catholic University of Korea College of Medicine, Uijeongbu St. Mary's Hospital5, Uijeongbu, Chosun University College of Medicine6, Gwangju, Chonbuk National University Medical School7, Jeonju, University of Ulsan College of Medicine and Gangnung Asan Hospital8, Gangnung, Hanmaeum General Hospital9, Jeju, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine10, University of Ulsan College of Medicine and Asan Medical Center11, Seoul, Nursing College, Gachon University, Incheon12, Infection Control Office, The Catholic University of Korea College of Medicine, St. Vincent's Hospital13, Suwon, Department of Clinical Nursing, University of Ulsan College of Medicine14, Ulsan, Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center15, Seoul, Korea

Received: August 21, 0213; Revised: October 10, 2013; Accepted: October 18, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) 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

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