Open Access Open Access  Restricted Access Subscription or Fee Access

Prevalence of Bacterial Colonisation in Patients Undergoing Hemodialysis: Experience from a Tertiary Care Centre

Geetanjali Loomba, Nitya Batra, Manju Dhandapani, Sukhpal Kau, Sandhya Ghai, Manisha Biswal, Raja Ramachandran


Routine surveillance of patients on hemodialysis is necessary to prevent and control skin colonization and staphylococcal infections. To assess the prevalence of bacterial colonization on various skin sites in patients undergoing hemodialysis. A cross-sectional study was conducted on adult patients at a tertiary care center of North India. Study was conducted from July 2016 to September 2016 on adult patients with newly diagnosed end stage renal disease (ESRD) on maintenance hemodialysis via internal jugular vein catheter. Pre-Moistened, sterile cotton swabs were used to collect samples from various sites (anterior nares, throat, dialysis catheter insertion site, axilla and toe webs) for colonization study. Identification of isolates received was done by the Bruker Biotyper MALDI-TOF. Species level identification was considered reliable at identification score of more than 2.0 and genus level identification was considered acceptable with identification score of more than 1.7 and less than 2.0. Primary outcome of the study was prevalence of bacterial colonisation in patients undergoing hemodialysis at various skin sites. Seventy two patients were enrolled with mean age of 42.4±13.41 years and 66% were males. Coagulase negative bacteria were more predominant at all the skin sites of patients as compared to coagulase positive bacteria. S. aureus was most prevalent at anterior nares (6.9%) followed by site of catheter insertion (4.2%), throat (2.8%), toe webs (2.8%) and axilla (1.4%). Methicillin resistant S. aureus was found at anterior nares (60%) and throat site (50%). Microorganism colonisation is prevalent among ESRD patients undergoing hemodialysis. Preventive strategies should be employed for such patients in order to prevent occurrence of infections. Early identification will aid in reducing the prevalence of infection related complications in this population.


Colonisation, end stage renal disease, hemodialysis, Staphylococcus

Full Text:



Grothe C, Belasco A, Bettencourt A, Diccini S, Vianna L, Pignatari A, et al. Lethality of endocarditis due to S. Aureus among patients on hemodialysis. Nephrol Nurs J. 2009; 36(6): 613–32p.

U.S. Renal Data System, USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2012.

Yang ES, Tan J, Eells S, Rieg G, Tagudar G, Miller LG. Body site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections. Clin Microbiol Infect. 2010; 16: 425–31p.

Nabi Z, Anwar S, Barhamein M, Al Mukdad H, El Nassri A. Catheter related infection in hemodialysis patients. Saudi J Kidney Dis Transplant. 2009; 20: 1091–95p.

Fitzgibbons LN, Puls DL, Mackay K, Forrest GN. Management of gram positive coccal bacteraemia and hemodialysis. Am J Kidney Dis. 2011; 57(4): 624–40p.

Wertheim HF, Vos MC, Ott A, Belkam AV, Voss A, Klutytmans JAJW, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet. 2004; 364(9435): 703–05p.

Pena C, Fernandez-Sabe N, Cominguez MA, Pujol M, Martinez-Castelao A, Ayats J, et al. Staphylococcus aureus nasal carriage in patients on hemodialysis: role of cutaneous colonisation. J Hosp Infect. 2004; 58: 20–27p.

Von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med. 2001; 344: 11–16p.

Devraj A, Pinnamaneni VST, Biswal M, Ramachandran R, Jha V. Extranasal Staphylococcus aureus colonisation predisposes to bloodstream infections in patients on hemodialysis with noncuffed internal jugular vein catheters. Hemodial Int. 2016; 21(1): 35–40p.

Sychev D, Maya ID, Allon M. Clinical management of dialysis catheter-related bacteremia with concurrent exit-site infection. Semin Dial. 2011; 24: 239–41p.

Minga T, Flannagan K, Allon M. Clinical consequences of infected arteriovenous grafts in hemodialysis patients. Am J Kidney Dis. 2001; 38: 975–8p.

Chiller K, Slekin B, Murakawa G. Skin microflora and bacterial infections of the skin. J Investig Dermatol Symp Proc. 2001; 6: 170–4p.

Loomba G, Dhandapani M, Kaur S, Ghai S, Biswal M, Ramachandran R, et al. The effectiveness of personal hygiene practices on non-cuffed central vein catheter-related infection in patients undergoing hemodialysis: A randomized controlled trial. Indian J Nephrol. 0; 0: 0. (DOI:10.4103/0971-4065.258648)

Goldblum SE, Reed WP, Ulrich JA, Goldman RS. Staphylococcal carriage and infections in hemodialysis patients. Nephrol Dial Transplant.1978; 7: 1140–48p.

Goldblum SE, Ulrich JA, Goldman RS, Reed WP. Nasal and cutaneous flora among hemodialysis patients and personnel: quantitative and qualitative characterization and patterns of staphylococcal carnage. Am. J. Kidney Dis.1982; 2: 281–86p.

Goldblum SE, Ulrich JA, Goldman RS, Reed WP. Nasal and cutaneous Staphylococcus among patients receiving hemodialysis and attending personnel. J. Infect. Dis. 1982; 145: 396p.

Kirmani N, Tuazon CU, Murray HW, Parrish AE, Sheagren JN. Staphylococcus aureus carriage rate of patients receiving

long-term hemodialysis. Arch Intern Med. 1978; 138: 1657–59p.

Boelaert JR. Staphylococcus aureus infection in haemodialysis patients. Mupirocin as a topical strategy against nasal carriage: a review. J Chemother. 1994; 6 Suppl 2: 19–24p.

Doebbeling BN. Nasal and hand carriage of Staphylococcus aureus in healthcare workers. J Chemother. 1994; 6(Suppl 2): 11–17p.

Boelaert JR, Van Landuyt HW, Gordts BZ, De Baere YA, Messer SA, Herwaldt LA. Nasal and cutaneous carriage of Staphylococcus aureus in hemodialysis patients: The effect of nasal mupirocin. Infect Control Hosp Epidimol. 1996; 17: 809–11p.

Goldblum SE, Ulrich JA, Goldman RS, Reed WP. Nasal and cutaneous flora among hemodialysis patients and personnel: Quantitative and qualitative characterization and patterns of Staphylococcal carriage. Am J Kidney Dis.1982; 2: 281–86p.

Kaplowitz LG, Comstock JA, Landwehr DM, Dalton HP, Mayhall CG. Prospective Study of Microbial Colonization of the Nose and Skin and Infection of the Vascular Access Site in Hemodialysis Patients. J Clin Microbiol. 1988; 26(7): 1257–62p.

Doebbeling BN, Breneman DL, Neu HC, Aly R. Elimination of S. aureus nasal carriage in healthcare workers: analysis of six clinical trials with calcium mupirocin ointment. Clin Infect Dis. 1993; 17: 466–74p.

Quinn RR, Lamping DL, Lok CE. The Vascular Access Questionnaire: assessing patient-reported views of vascular access. J Vasc Access. 2008; 9(2): 122–28p.

Mahak C, Shashi Y, Hemlata NM, Sandhya G, Dheeraj K, Dhandapani M, Dhandapani SS. Assessment of utilization of rehabilitation services among stroke survivors. J Neurosci Rural Pract. 2018 Oct; 9(4): 461p.

Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Stud Group. 2001; 344(1): 11–6p.

Carbonnelle E, Grohs P, Jacquier H, Day N, Tenza S, Dewailly A, et al. Robustness of two MALDI-TOF mass spectrometry systems for bacterial identification. J Microbiol Meth. 2012; 89: 133–6p.

Yu VL, Goetz A, Wagener M. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. N Engl J Med.1986; 315: 91–96p.

Davies SJ, Ogg CS, Cameron JS, Poston S, Noble WC: Staphylococcus aureus nasal carriage, exit site infection and catheter loss in patients treated with continuous ambulatory peritoneal dialysis. Perit Dial Int. 1989; 9: 61–64p.

Katneni R and Hedayati SS. Central venous catheter-related bacteraemia in chronic hemodialysis patients: epidemiology and evidence-based management. Nat Clin Pract Nephr. 2007; 3(5): 256–66p.

Fram D, Okuno MF, Taminato M, Ponzio V, Manfredi SR, Grothe C, et al. Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a casecontrol study. BMC Infect Dis. 2015; 15: 158–64p.

Gauna TT, Oshiro E, Luzio YC, Paniago AM, Pontes ER, Chang MR. Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil. Rev Soc Bras Med Trop. 2013; 46 Suppl 4: 426–32p.

Fysaraki M, Samonis G, Valachis A, Daphnis E, Karageorgopoulos DE, Falagas ME, et al. Incidence, clinical, microbiological features and outcome of bloodstream infections in patients undergoing hemodialysis. Int J Med Sci. 2013; 10 Suppl 12: 1632–8p.

Esmanhoto CG, Taminato M, Fram DS, Belasco AGS, Barbosa DA. Microorganisms isolated from patients on hemodialysis by central venous catheter and related clinical evolution. Acta Paul Enferm. 2013; 26 Suppl 5: 413–20p.

Zimakoff J, Pedersen FB, Bergen L, et al. and DASPID: Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal dialysis centres in Denmark. J Hosp Infect.1996; 33: 289–300p.

Astor BC. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J Am Soc Nephrol. 2005; 16: 1449–55p.

Bogut A, Koziol-Montewka, Baranowicz I, Jozwiak L, Ksiazek A, Al-doori Z. Characterisation of Staphylococcus aureus nasal and skin carriage among patients undergoing hemodialysis treatment. New Microbiol. 2007; 30: 149–54p.

Lai CF, Liao CH, Pai MF, Chu FY, Hsu SP, Chen HY, et al. Nasal carriage of methicillin-resistant Staphylococcus aureus is associated with higher all-cause mortality in hemodialysis patients. Clin J Am Soc Nephrol. 2011; 6(1): 167–74p.

Ghasemian R, Najafi N, Makhlough A, Khademloo M. Frequency of nasal carriage of Staphylococcus aureus and its antimicrobial resistance pattern in patients on hemodialysis. Iran J Kidney Dis. 2010; 4: 218–222p.

Aminzadeh Z, Mastari Farahani A, Gchkar L. Prevalence of Staphylococcus aureus carriage in patients on hemodialysis and the pattern of antibacterial resistance. Iran J Clin Infect Dis. 2006; 1: 5–10p

Tashakori M, Moghadam FM, Ziasheikholeslami N, Jafarpour P, Behsoun M, Hadavi M, et al. Staphylococcus aureus nasal carriage and patterns of antibiotic resistance bacterial isolates from patients and staff in a dialysis center of southeast Iran. Iran J Microbiol. 2014; 6(2): 79–83p.

Dhandapani SS, Manju D, Vivekanandhan S, Agarwal M, Mahapatra AK. Prospective longitudinal study of biochemical changes in critically ill patients with severe traumatic brain injury: Factors associated and outcome at 6 months. Indian J Neurotrauma. 2010 Jun; 7(01): 23–7p.

Dhandapani M, Gupta S, Mohanty M, Gupta SK, Dhandapani S. Prevalence and trends in the neuropsychological burden of patients having intracranial tumors with respect to neurosurgical intervention. Ann Neurosci. 2017; 24(2): 105–10p

Dhandapani S, Goudihalli S, Mukherjee KK, Singh H, Srinivasan A, Danish M, Mahalingam S, Dhandapani M, Gupta SK, Khandelwal N, Mathuriya SN. Prospective study of the correlation between admission plasma homocysteine levels and neurological outcome following subarachnoid hemorrhage: A case for the reverse epidemiology paradox? Acta Neurochirurgica. 2015 Mar 1; 157(3): 399–407p.

Center For Disease Control And Prevention: Guidelines for the prevention of intravascular catheter-related infections. MMWR. 2002; 51: 1–29p.


  • There are currently no refbacks.