Vascular Access Infection Associated with Methicillin-Resistant <i>Staphylococcus aureus </i>Nasal Carriage in a Hemodialysis Patient

Kazuhito Takeda, MD, Kidney Center, Saiseikai Yahata Hospital, 5-9-27 Harunomachi, Yahatahigashi-ku, Kitakyushu, Fukuoka 805 (Japan) Dear Sir, Infection with methicillin-resistant Staphylococcus aureus (MRSA) is one of the major opportunistic hospital infections. MRSA infections cause significant morbidity and mortality in compromised hosts, particularly in the hospital environment. A high incidence of MRSA nasal carriage (MRSA-NC) has been frequently reported in chronic dialysis patients. There is a high risk of bacter-emia in hemodialysis (HD) patients with MRSA-NC as well as a high incidence of exit-site infections or peritonitis in patients treated with continuous ambulatory peritoneal dialysis (CAPD) [1, 2]. Few reports have found severe vascular access infections associated with MRSA-NC in HD patients immediately after the vascular access operation. We herein report a case who suffered from vascular access infection associated with MRSA-NC. A 79-year-old male undergoing maintenance HD was referred from another hospital because ofvascular access complications. The patient had been operated on for a primary standard arteriovenous fistula (AVF) for vascular access in the left forearm, but a few days later the access had failed owing to S. aureus infection, and a similar operation for the vascular access had been performed in the right ellbow area, but the access had failed again because of severe infectious bleeding due to MRSA, and the right bra-chial artery had been partially resected and reconstructed because of the access infection to the artery. The patient had taken sufficient energy and proteins before operations, and had been in good health. Causes of access infections were not clearly elucidated. Physical examination at the time of admission to our hospital revealed: access operation scars in bilateral arms, a body temperature of 36.0°C, a heart rate of 78 beats/min, and blood pressure of 132/72 mm Hg. Laboratory studies showed: hemoglobin 9.4 g/dl, hematocrit 28.8%, white cell count 5,400/μl, platelets 12.8 × 104/μl, blood urea nitrogen 32 mg/dl, serum creatinine 6.5 mg/dl and total protein 6.0 g/dl. Physical examination and laboratory investigation established no inflammation. According to bacteriological examinations, microscopical examinations of sputum, blood, and throat swab were negative for MRSA, and urine cultures were sterile. However, nasal swab culture disclosed