الفهرس 
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Abstract
This study included eighty patients with ESRD on regular haemodialysis and twenty-five medical staff; all of them were subjected for detection of MRSA nasal carriage. All haemodialysis patients subjected also for detection of MRSA bacteremia and CVC colonization.
All patients and medical staff were subjected to full medical history, clinical examination and nasal swab culture. All patients subjected for blood culture and CVC cultures in patients dialyzed by it.
Our study showed that nasal carriage of S. aureus presented in 27.5% of all patients and MRSA nasal carriage was 13.8% of all patients. Only one healthcare worker carried MSSA strain. There was significant increase of nasal carriage percentage with advancing age, increase dialysis duration, diabetes mellitus and history of infection and antibiotic use during three months follow up. There was no significant increase of nasal carriage in relation to sex, type of vascular access, hypertension and chronic liver disease.
Our study showed positive S. aureus bacteremia presented in 15% of all patients and MRSA bacteremia was 6.3% of all patients. There was significant increase of bacteremia percentage with advancing age, increase dialysis duration, hypertension, chronic liver disease, history of infection and antibiotic use during three months follow up, type of vascular access (more with CVCs then a-v graft and the safest was a-v fistula) and presence of nasal carriage. There was no significant increase of bacteremia in relation to sex and diabetes mellitus.
In our study, we cultured the tips of CVCs to detect colonisation. Out of 11 CVCs, there were six catheters colonized with S. aureus (3 with MRSA, 2 with MSSA and 1 with intermediate resistant S. aureus). There was significant increase of CVCs colonisation in relation to presence of nasal carriage. There was no significant increase of CVCs colonisation in relation to sex, diabetes, hypertension, chronic liver disease, history of infection and antibiotic use during three months follow up and duration of catheterization.
Infection control measures in haemodialysis unit must be followed in order to decrease the risk of infection and antibiotic resistance. The recommendations in our study provide guidelines for a comprehensive infection control program that includes: a) infection control practices specifically designed for the haemodialysis setting, including routine testing and immunization; b) surveillance; and c) training and education. HAND WASHING IS THE MOST IMPORTANT WAY OF PREVENTING THE SPREAD OF MRSA. We encourage all staff to practice hand cleansing between patients.
Nasal carriage is important risk factor as a source for haemodialysis infection. Our study recommends using periodic surveillance evaluation of presence of carriage state and rapidly treating it effectively.
The most important strategy in preventing infections in haemodialysis patients is to use the lowest risk vascular access, i.e., artrio-venous (A-V) fistulae in preference to grafts, and minimize the use of haemodialysis catheters.
However, it seems inevitable that resistance will ultimately occur, and strategies to reduce the speed with which this happens should implement. Measures include good infection control, reliable laboratory screening for resistance, and good prescribing practices within a framework driven by protocol and audit, and the avoidance of blanket treatment. Individual units will be required to develop tailored strategies for antibiotic use, a guiding principle of which must include informed and considered use of this valuable agent.
Implementation of this program in haemodialysis centers will reduce opportunities for patient-to-patient transmission of infectious agents, directly or indirectly via contaminated devices, equipment and supplies, environmental surfaces, or hands of personnel.