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Background: Dialysis patients are frequently exposed to Staphylococcus aureus due to stays in dialysis centers, hospitals or rest homes. The hemodialysis vascular access is a potential entry site for S. aureus, in particular when using a central venous catheter (CVC) which increases the risk of sepsis compared to arteriovenous (AV) fistula. We prospectively followed a cohort of 86 hemodialysis patients from an outpatient dialysis center over 25 months analyzing S. aureus carrier status, S. aureus infection rates and mortality., Methods: Demographic data and patients´ medical histories were collected and followed from all hemodialysis patients. Blood samples, nasal swabs and swabs from the hemodialysis vascular access site were taken every six months for a period of 25 months and tested for S. aureus. Strains were cultured and further characterized by spa PCR and microarray-based genotyping. Resulting data were compared with those from the general population., Results: In cross-sectional analyses, an average of 40% of hemodialysis patients were S. aureus carriers compared to 27% in the general population. Longitudinally, a total of 65% were S. aureus carriers: 16% were persistent carriers, 43% were intermittently colonized. The most common S. aureus lineage in the dialysis patient cohort was the clonal complex (CC) 8 and the spa type t008, while in the general population, the clonal complex CC30 dominates. During the study period, we observed six S. aureus-associated blood stream infections with one S. aureus attributable death. S. aureus carriers with an AV fistula were more densely colonized in the nasal mucosa compared to patients with a CVC. Overall mortality was lower for hemodialysis patients with a positive S. aureus carrier status compared to non-carriers (hazard ratio of 0.19)., Conclusions: Compared to the general population, hemodialysis patients were more frequently colonized with S. aureus and displayed both different S. aureus colonization densities as well as lineages, possibly explained by more frequent exposure to health care environments. The lower overall mortality in carriers compared to non-carriers is intriguing and will be investigated in detail in the future., Trial Registration: ISRCTN 14385893 , 2. October 2018, retrospectively registered.

Objective: Staphylococcus aureus nasal carriage screening among hemodialysis patients is not standard practice in Thailand, because of data lacking regarding prevalence and correlation with subsequent infection. We aimed to investigate the prevalence of S. aureus nasal carriage and its association with bloodstream infection among hemodialysis patients. In this prospective multicenter cohort study, participants were screened for S. aureus nasal carriage over 2 consecutive weeks. Incidence of S. aureus bloodstream infection over the next 12 months was observed. Results: The prevalence of S. aureus nasal carriage was 11.67%. Incidence of S. aureus bacteremia among participants with and without S. aureus nasal carriage were 7.1% and 3.8%, respectively. The odds ratio for nasal carriage and subsequent bacteremia was 1.96 (95% CI 0.04–21.79; p = 0.553). Survival analysis showed that time to bacteremia among participants in the two groups did not significantly differ (p = 0.531). Prevalence of S. aureus nasal carriage among hemodialysis patients in Thailand was low. Patients presenting with 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. [ABSTRACT FROM AUTHOR]