ABSTRACT
Nasal carriage among hospital personnel is an important source of nosocomial staphylococcal infection. Therefore, this study aims to evaluate Staphylococcus aureus nasal colonisation among healthcare workers (HCWs) and its association with infection in children through analysis of antibiotic susceptibility profiles and genetic similarity. Nasal swabs were taken from the anterior nares of HCWs and also a total of 130 strains that had been isolated from various clinical samples were examined. Antibiotic susceptibility profiles of the strains were determined using the disc-diffusion technique and genotyping was performed by amplification of the enterobacterial repetitive intergenic consensus sequences (ERIC-PCR). Approximately 48% of clinical strains obtained were methicillin-resistant S. aureus (MRSA), whereas only 24.7% of strains from HCWs were MRSA. Among isolates from HCWs, cephalothin, cefazolin, chloramphenicol, rifampicin and vancomycin were most effective, with susceptibility rates of 100%. In this study, the ERIC-PCR profiles did not reveal any genetic similarity among the S. aureus strains from HCWs and the clinical samples. In contrast, MRSA strains showed clonal dissemination, with clones D and A2 predominant among patients and HCWs, respectively. No association was observed between the MRSA nasal carriers and infections in patients. These findings suggest that MRSA nasal carriage among HCWs may not be the source of related infections in the group studied.
Subject(s)
Health Personnel/statistics & numerical data , Inpatients/statistics & numerical data , Staphylococcal Infections/diagnosis , Staphylococcal Infections/microbiology , Staphylococcus aureus/genetics , Staphylococcus aureus/isolation & purification , Child , Cross Infection/diagnosis , Cross Infection/epidemiology , Cross Infection/microbiology , Genotype , Humans , Iran/epidemiology , Occupational Diseases/diagnosis , Occupational Diseases/epidemiology , Occupational Diseases/microbiology , Staphylococcal Infections/epidemiology , Tertiary Care Centers/statistics & numerical dataABSTRACT
OBJECTIVE: End-stage renal disease (ESRD) poses steadily growing challenges to health care systems worldwide. Renal replacement therapy with hemodialysis (HD) or kidney transplantation is the only possibility for ESRD patient survival. A complete correction of anemia in HD patients may lead to an increased risk of vascular arteriovenous fistula (AVF) primary failure; some studies have demonstrated that decreased levels of hemoglobin (Hb) had adverse effects on cardiac and brain function. This study was designed to evaluate the impact of different risk factors, especially the Hb level on AVF survival. METHODS: Prospective observational data were analyzed from a non-randomized sample (n=100) of HD patients who were referred for first AVF creation between April 2005 and December 2006 with <1 month on HD. The relative risk (RR) of access primary failure was evaluated in four different groups of patients divided according to their Hb levels (<8, 8-10, 10-12, and >12 g/dL). Other factors possibly influencing vascular access (VA) survival were also considered including gender, age, smoking, diabetes, hypertension, parathyroid hormone levels, ACE inhibitor intake and triglyceride levels. The analyses were performed using SPSS v.11.5, Kaplan-Meier analysis, Cox's regression and log rank test. RESULTS: There was a statistically significant higher risk of AVF primary failure in patients with Hb <8 g/dL (RR=1.41; p=0.01), diabetes (RR=1.21; p=0.05), age>60 yrs (RR=1.41; p=0.06) were identified as predictive factors for AVF primary failure. ACE inhibitor intake (RR=0.45; p=0.01) was found to be protective. CONCLUSION: Correction of serum Hb level can lead to a better result in VA survival and ACE inhibitor intake was found to be a protective factor.
