impact of nurse understaffing on the transmission of hepatitis C virus in a hospital based hemodialysis unit

To determine the impact of nurse understaffing on the transmission of hepatitis C virus [HCV] infection in a large hospital-based hemodialysis [HD] unit with a high HCV prevalence. Subjects and The records of 198 patients [107 males and 91 females] with end-stage renal disease enrolled on long-term HD at King Fahad Hospital and Tertiary Care Center, Hofuf, Saudi Arabia, from August 1995 to August 2000, were retrospectively reviewed. The patients were assigned to HD groups of varying patient-to-nurse [P/N] ratios: group I, 2:1; group II, 3:1, and group III, 4:1. HCV prevalence, seroconversion rates, history of blood transfusion and dialysis age [time span since the initiation of the HD treatment] were recorded and compared. The overall HCV prevalence and seroconversion rate per year were 43.4 and 8.6%, respectively. Group I had the lowest HCV prevalence and annual seroconversion rate [26.8%; 5.3%], followed by group II [43.6%; 8.7%]; group III had the highest HCV prevalence and seroconversion rate [71.8%; 14.4%]. Anti-HCV positivity was associated with a higher dialysis age. The finding that the patients in the groups with the relatively higher P/N ratio had the significantly higher HCV prevalence and seroconversion rates per year indicates that understaffing is likely to play a major role in the transmission of HCV in HD units, and we suggest that improved staffing may be helpful in reducing the HCV transmission in such dialysis units

Emerging nalidixic acid and ciprofloxacin resistance in non-typhoidal Salmonella isolated from patients having acute diarrhoeal disease

Background: Non-typhoidal Salmonella are one of the key etiological agents of diarrhoeal disease. The appearance of multiple drug resistance along with resistance to quinolones in this bacterium poses a serious therapeutic problem. We determined the prevalence of nalidixic acid and ciprofloxacin resistance in non-typhoidal Salmonella isolated from faecal samples of patients with acute diarrhoeal disease attending the outpatient and inpatient department of a hospital in Saudi Arabia during the years 1999 to 2002

Methods: Non-typhoidal Salmonella were isolated from faecal samples. Antimicrobial susceptibility was tested by the disc diffusion test. MICs to nalidixic acid and ciprofloxacin were determined by the agar dilution method

Results: During the study period, 524 strains of non-typhoidal Salmonella were isolated. Strains belonging to serogroup C1 were the commonest [41.4%] followed by serogroups B and D [15.6% and 14.5%, respectively]. Resistance to ampicillin was observed in 22.9% and to trimethoprim/sulfamethoxazole in 18.5% of the strains. Nalidixic acid resistance was encountered in 9.9% and ciprofloxacin resistance in 2.3% of the strains. Resistance to nalidixic acid significantly increased from 0.1% in 1999 to 5.5% in 2002 [P=0.0007] and ciprofloxacin resistance increased significantly from 0.1% in 1999 to 0.9% in 2002 [P=0.0001]. MICs to nalidixic acid and ciprofloxacin were determined among 29 nalidixic acid-resistant strains of non-typhoidal Salmonella isolated during 2002. The MIC was >256 microg/mL to nalidixic acid and 8 to 16 microg/mL to ciprofloxacin

Conclusion: The increasing rates of antimicrobial resistance encountered among non-typhoidal Salmonella necessitate the judicious use of these drugs in humans. Moreover, these findings support the concern that the use of quinolones in animal feed may lead to an increase in resistance and should be restricted

Advancing age and the risk of nasal carriage of Staphylococcus aureus among patients on long-term hospital-based hemodialysis

Background: Elevated nasal carriage rates of Staphylococcus aureus and ensuing complications among the elderly and in those on long-term hemodialysis [HD] are well recognized. The aim of the present study was to determine the extent to which advancing age is associated with the risk of persistent S. aureus nasal carriage among end-stage renal disease [ESRD] patients on long-term HD

Patients and Methods: This prospective study involved 205 ESRD patients enrolled for maintenance HD from July 1997 to July 2000. Persistent nasal carriage was defined by two or more positive cultures for methicillin-susceptible [MSSA] or methicillin-resistant S. aureus [MRSA]. Five standardized swabs were taken from the anterior nares of all the patients on long-term HD. S. aureus nasal carriage rates were estimated and compared among ESRD patients of different age groups

Results: Overall, a prevalence of 38.05% [78/205] for S. aureus nasal carriage was observed, including 27.3% [56/205] for MSSA and 10.7% [22/205] for MRSA. Patients aged 75 to 84 years had the highest [84.6%, 11/13] prevalence of S. aureus nasal carriage [RR, 7.000, 95% CI, 4.350-11.763, P<0.00001]. Those aged 65 to 74 years had the next highest [49.0%, 25/51] nasal carriage rates [RR, 4.083, 95% CI, 2.302-7.658, P<0.0001] while patients aged 15 to 24 years [reference group] had the lowest [12.8%, 1/8] prevalence of nasal carriage. The 75 to 84 year age group also had the highest rates of MSSA [46.2%, 6/13], [RR- 3.833, 95% CI, 2.144-7.234, P<0.0001] and MRSA [38.5%, 5/13] [RR, 6.333, 95%CI, 2.767-16.198, P<0.0001] nasal carriage compared to the reference group

Conclusion: Significantly higher persistent MSSA and MRSA nasal carriage rates among ESRD patients >75 years of age are suggestive of an elevated risk of potentially serious S. aureus- related complications among the very elderly during long-term HD. These findings might be helpful in the identification of elderly HD patients as a high-risk group for S. aureus-linked vascular access-related septicemia [VRS] and to evolve appropriate preventive strategies