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. CONCLUSIONS: 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.