RESUMO
Hemodialysis (HD) patients are at risk for developing serious infections. Methicillin- resistant Staphylococcus aureus (MRSA) is one of the most prevalent pathogens in healthcare facilities with a major threat to the medical community. We aimed to determine the prevalence of MRSA colonization among patients and medical staff members in a HD Unit and determine efficacy of mupirocin as a decolonizing agent. This cross-sectional study enrolled 250 patients and 35 health care providers of a HD unit. Nasal and hand swabs were collected to assess the prevalence of MRSA carriage. Those exhibiting MRSA phenotype were subjected to conventional Polymerase chain reaction (PCR) assay for detection of mecA gene. Colonized patients and medical personnel with MRSA were prescribed mupirocin ointment (2%) for decolonization. The screening approach identified 54/285 (18.9%) nasal MRSA carriers (41/250 of HD patients and 13/35 of the medical staff members). Concomitant extranasal MRSA colonization of the hands was observed in 10 (18.5%) of these 54 MRSA carriers. In relation to PCR results the sensitivity, specificity, and diagnostic accuracy of cefoxitin disk test were 98.2%, 75%, and 93.9% respectively and for MRSA Select II agar screening method, the sensitivity, specificity, and diagnostic accuracy were 92.6%, 66.7%, and 87.9% respectively. Decolonization approach using mupirocin ointment revealed an overall success rate up to 77.8% (42/54) and failure rate of 16.7% (9/54), while 5.6% (3/54) of decolonized carriers showed recolonization. There is still high prevalence of MRSA colonization in HD vicinity. Implementation of strict infection control measures is essential in dialysis units to avoid MRSA cross-transmission and invasive infections.
RESUMO
Vascular access complications are major issues in hemodialysis (HD) patients, which increase their morbidity and lessen HD efficiency. The aim of this study was to assess von Willebrand factor (VWF), and a disintegrin and metalloproteinase with eight thrombospondin-type 1 motif (ADAMTS13) levels in HD patients and their association with vascular access thrombosis (VAT). This study included a total of 158 individuals including 128 patients undergoing HD for more than 6 months, subdivided into two groups according to the occurrence of the previous episode of VAT; 60 HD patients with VAT and 68 HD patients without VAT and 30 healthy controls. Plasma ADAMTS13 and VWF levels were assessed by enzyme-linked immunosorbent assay technique. There were higher VWF levels and lower ADAMTS13 in HD patients, compared to healthy controls. Furthermore, VWF levels were significantly higher and ADAMTS13 levels were significantly lower in HD patients with VAT than those without VAT. Further prospective studies with large number of patients are thus needed to show if there is causal relationship between higher VWF levels, lower ADAMTS13, and VAT.
RESUMO
The triggering receptor expressed on myeloid cells-1 (TREM-1) is a member of the immunoglobulin superfamily. TREM-1 has been implicated as an amplifier of inflammation. Soluble TREM-1 (sTREM-1) was investigated in different clinical conditions, but not in hemodialysis (HD) patients. We aimed to investigate sTREM-1 as a marker of inflammation in HD patients. We investigated 40 CKD patients undergoing chronic HD treatment and 15 controls. Routine laboratory investigations in addition to CRP measured by immunoturbidimetry, TNF- α, and sTREM-1 measured by ELISA were assayed in post-hemodialysis patients' blood samples and in controls' blood samples. CRP, TNF-α, and sTREM-1 levels were significantly higher in HD patients than in controls (p < 0.001 for all). sTREM-1 was positively correlated with CRP and TNF-α (r = +0.50, p < 0.001 and r = +0.53, p < 0.001 respectively). It was negatively correlated with hemoglobin concentration (r = -0.69, p < 0.001). Hemoglobin concentration was the significant predictor of sTREM-1 level (p < 0.001). In conclusion, sTREM-1 level is significantly increased in HD patients as are other pro-inflammatory markers.
