From April 2007, all centres providing Renal Replacement Therapy in England were asked to provide additional data on patients with Methicillin Resistant Staphylococcus aureus (MRSA) bacteraemia using a secure web-based system. Data were recorded on modality of treatment and the type of vascular access in use at diagnosis and in the previous 28 days. From April 2007 until March 2008, 188 discrete episodes of MRSA bacteraemia were reported in patients receiving dialysis for established renal failure. Over the same period 4,448 MRSA bacteraemias were reported in England, indicating that 4.2% of all cases occurred in dialysis patients. Of the 188 episodes, additional data from the renal centres were available in 92 cases (49%). All patients with completed records were on haemodialysis at the time of the bacteraemia. Of those, 65/92 (70.7%) were using venous catheters, the majority tunnelled lines (n = 55, 59.8%), and 2 other cases had used venous catheters in the previous 28 days. The relative risk of MRSA bacteraemia was about 100 fold higher for a dialysis patient in comparison to the general population and 8 fold higher for a patient using a catheter in comparison to a fistula. The mean rate for all patients was 0.92-0.85 episodes/100 prevalent dialysis patients/year but the rate varied between renal centres with a range of 0-3.28. Using just haemodialysis patients as the denominator, the mean was 1.14-0.95 episodes/100 patients/year with a range of 0-3.93. Compared to previous Registry reports, absolute numbers of reported MRSA bacteraemias has fallen by approximately 62% from 2004. Many centres have substantially reduced the numbers of cases. Dialysis patients are at increased risk of MRSA bacteraemia; this is closely associated with the use of venous catheters. The rate of MRSA bacteraemia is falling substantially within the prevalent dialysis population, but with variation in performance between centres.
- Vascular access