Staphylococcus aureus Nasal Carriage and Blood Stream Infection among Conventional Hemodialysis Patients in Thailand: a Prospective Multicenter Cohort Study

Abstract Objective: Staphylococcus aureus nasal carriage screening among hemodialysis patients is not a standard practice in Thailand, because of lacking data in prevalence and the correlation with subsequent infection. We aimed to investigate the prevalence of S. aureus nasal carriage and its association with blood stream infection among hemodialysis patients. In this prospective multicenter cohort study, each participant was screened for S. aureus nasal carriage once weekly for two consecutive weeks. Incidence of S. aureus bloodstream infection within 12 months after the last sample collection was observed.Results: The prevalence of S. aureus nasal carriage was 11.67%. Incidence of S. aureus bacteremia among participants presenting S. aureus nasal carriage and non-carriers were 7.1 % and 3.8%, respectively. The odds ratio for nasal carriage to develop bacteremia was 1.96 (95% CI 0.04-21.79; p=0.553). Survival analysis showed that time to bacteremia among participants with and without nasal carriage did not significantly differ (p =0.531). Prevalence of S. aureus nasal carriage among hemodialysis patients in Thailand was low. Patients presenting S. aureus nasal carriage did not have increased risk of S. aureus bacteremia after 12-month follow-up. Nasal S. aureus screening and decolonization should not be encouraged in this setting.