الفهرس | Only 14 pages are availabe for public view |
Abstract The Staphylococcus aureus are considered as the most causing of such infections being one of the important and principal morbid factors that cause the blood infections among Hemodialysis populations. Nasal carriage of Staphylococcus aureus is a recognized risk factor for the development of hemodialysis CRBSIs of endogenous origin. The vestibulum nasi are the main ecological niche where the organisms colonize and then disseminate to the other parts of the body. This work included 40 patients who were received hemodialysis with inserted temporary dialysis catheters in Ain Shams University Hospitals, Egypt. All patients who were received temporary dialysis catheters were observed for the occurrence of any local or systemic infections. All Patients were subjected to the following: 1- Full medical history . - Personal history. - Dialysis-session length in-hours. All patients had 3 dialysis sessions per week. - Co-morbidities like diabetes mellitus (as a disease accompanied with infections). 2- Clinical examination particularly for fever, any local (at catheter exit site) or systemic infection. 3- Laboratory investigations. Our results demonstrated that more than half of the participants (52.5%) were between 40-59 years; while (37.5%) were 60 years or more and only 10.0% were between 20-39 years. The mean age of the participants was 54.6 + 11.3 and their ages range from 22-81 years, and relation between Staphylococcus aureus nasal carriage and Age of the participants of ( 40- 59 y) 47.6% and patients > 60 years were 46%. 55% of the study participants were males while 45.0% were females. In addition there is no statistically significant difference between the studied participants as regard their gender (P>0.05). Our results demonstrated that Moreover (100%) of study participants were having chronic kidney disease, (35%) were hepatitis c virus positive, (22.5%) were hypertensive and (20%) were diabetics, finally the majority of participants (87.5%) of the participants stayed 4 hours duration on the dialysis session, while (12.5%) stayed 3 hours; The mean duration of the dialysis session was about 3.87 + 0.33 hours and the duration of dialysis ranged from 3-4 hours. In addition to that there is a highly statistically significant difference between study participants as regard duration on dialysis session (P<0.01). Our results demonstrated that (12.5%) of the participants had fever as a presenting symptom, (12.5%) had chills, & (10%) had hypotension, In addition to that (45.0 %) of the participants had Positive nasal swab, (27.5%) had positive central blood culture and 3 patients had positive peripheral blood culture from 5 patients by (60%), moreover (75.0%) don’t have catheter exit site manifestations while it is present in (25.0%) of patients . Our results demonstrated that (81.8%) of the participants who had Positive central blood culture had positive nasal swab. In addition to that participants with positive nasal swab are 1.818 times more liable to develop positive central blood culture than patients with negative nasal swab (RR=1.818; 95%CI= (1.125-2.940). Our results demonstrated that shows that there is a statistically significant Relation between Staphylococcus aureus nasal carriage and CDC Criteria for infection including Fever, Chills and Hypotension (P<0.05); on the contrast there is no statistically significant Relation between Staphylococcus aureus nasal carriage and presence of catheter exit site (P>0.05). Our results demonstrated that Staph Coagulase –ve was the most frequent organism found in Central Blood Culture (45.5%), followed by Staph Coagulase +ve (36.4%), Ecoli and Pseudomonas each account for (9.1%) respectively. And shows that the presence of the three organisms Staph Coagulase –ve, Staph Coagulase +ve and Ecoli was the same in peripheral blood culture each one accounts for (33.3%) respectively. Data obtained show organisms retrieved from nasal swabs were most sensitive to Vancomycin & DA Our results demonstrated that (94.4% & 77.8%) respectively while 77.8% were resistant to FOX while 72.2% were resistant to E & SXT respectively., and organisms retrieved from central venous line were most sensitive to Vancomycin, DO & DA (100.0%, 90.9% & 81.8%) respectively while 100.0% were resistant to SXT while 63.7% were resistant to FOX and Erythromycin. Finally, organisms retrieved from peripheral line were most sensitive to Vancomycin, DA & CN (100.0%) sensitivity; while 100.0% were resistant to Erythromycin. Our results demonstrated that relationship between Central Blood Culture Organism and Peripheral Blood Culture Organism revealed that results of Peripheral Blood Culture Organism & Central Blood Culture Organism agreed on the same organism by 33.3% of cases did central and peripheral cultures and the organism Staph +ve coagulase. |